Ultrasound-guided compression closure of postcatheterization pseudoaneurysms during concurrent anticoagulation: A review of seventy-seven patients

Abstract

Successful UGCC of pseudoaneurysms occurred in a large percentage of patients receiving full-dose, uninterrupted anticoagulation. The only factor influencing success was the size of the pseudoaneurysm.

Contemporary Management of Postcatheterization Pseudoaneurysms

“…Seven (12.5%) of these patients required 2 or 3 compression attempts to induce sustained thrombosis. 30 There were no significant complications reported in either of these studies.…”

“…27,30 Two series from the same institution evaluated the role of USGC of postcatheterization PSAs in patients who did not receive anticoagulation and in those who did. 30,31 In the first 100 cases of postcatheterization PSA, USGC was immediately successful in 94 patients (94%), which included 30 (86%) of 35 patients who received anticoagulation and 64 (98%) of 65 patients who were not on anticoagulation. There were recurrences in a total of 10 patients who subsequently underwent repeat USGC 8 or surgery.…”

“…Rare complications have been reported such as vasovagal reactions, PSA rupture, skin necrosis, and deep vein thrombosis, although we have not experienced this in our large series. 30,31 Ultrasound-Guided Thrombin Injection UGTI has become the treatment of choice for postcatheterization PSAs. [32][33][34] Percutaneous coagulation of a PSA was first reported by Cope and Zeit in 1986.…”

Safety and Efficacy of a Potential Treatment Algorithm by Using Manual Compression Repair and Ultrasound-Guided Thrombin Injection for the Management of Iatrogenic Femoral Artery Pseudoaneurysm in a Large Patient Cohort

“…Because of assumable disadvantages of MC compared with UGTI, including long procedure times and patient and operator discomfort during compression, UGTI was installed as the primary option. 8,10 However, apart from incompressible PSAs, MC should directly be performed when morphological PSA features would predict potential risks for UGTI. Based on previous reports and own experience, we determined small diameter, an indefinable neck and direct adjacency of the PSA to vessels as relative and concomitant arteriovenous fistula as absolute contraindication for thrombin injection, the latter because of potential risk of thrombin leakage into the venous circulation.…”

“…5,6 Although the success rates of USGC range between 71% and 99%, this technique has disadvantages, including less effectiveness in patients receiving anticoagulation, long procedure times, and patient and operator discomfort during compression. [7][8][9][10] UGTI represents an elegant alternative with high success rates between 91% and 100% at low complication risk. 6,[11][12][13][14][15][16] For that reason, most experts recently recommend UGTI as the technique of choice for first-line management of PSAs rather than USGC or its simplified version the clinically guided manual compression repair without technical surveillance (MC).…”