Ultrasound-Guided Thrombin Injection for Postcatheterization Pseudoaneurysms and Its Extended Indications

Abstract

Objective: Ultrasound-guided thrombin injection (UGTI) is an option for the treatment of postcatheterization pseudoaneurysms. This method is less invasive and less time-consuming compared with other procedures since it can be performed without general anesthesia, skin incision, or occlusion of the artery. Herein, we report on the efficacy of UGTI for postcatheterization bleeding complications. Methods: Postcatheterization bleeding complications include postcatheterization pseudoaneurysm and failed hemostasis. In this study, failed hemostasis was defined as cases in which hemostasis could not be accomplished by 30 min of manual compression following sheath removal. A retrospective study of eight cases in which we performed UGTI for postcatheterization bleeding complications between July 2016 and June 2019 at our institution was performed to evaluate technical success and recurrence of pseudoaneurysm or rebleeding events. Results: Among these eight cases, there were three cases of pseudoaneurysm and five cases of failed hemostasis. In all cases, technical success was achieved without any complications such as distal embolism or allergic reaction. There were no recurrences of pseudoaneurysm or rebleeding events during an average follow-up of 5.25 months. Conclusion: We believe that UGTI is effective not only for postcatheterization pseudoaneurysms but also for failed hemostasis.

Balloon-Assisted Thrombin Injection of a Profunda Femoral Pseudoaneurysm Using Radial Access

“… 5 UGTI is the current preferred treatment of choice for most post-catheterization PSAs and has a success rate of 97.5%. 6 One major complication of UGTI is arterial embolization that may result in limb ischemia, the risk of which is increased by factors PSA with short necks and repeated thrombin injections. 7 Hence, adequate visualization of the PSA on ultrasound is imperative and was obscured in our patient due to patient habitus and overlying hematoma.…”