Ultrasound-guided thrombin injection in the management of pseudoaneurysm after percutaneous arterial access

Abstract

Aim: The purpose of this paper was to evaluate the efficacy of ultrasound-guided percutaneous thrombin injection as a treatment method for arterial access site pseudoaneurysm. Materials and methods: A total of 148 patients with iatrogenic arterial access site pseudoaneurysms were treated in the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin. Of those, 142 pseudoaneurysms were located in the common femoral artery, 3 in the brachial artery and the remaining 3 in the radial artery. The study included 77 woman and 71 men (mean age 64.5 ± 14 years). Patients were qualified for percutaneous thrombin injection after Doppler examination during which pseudoaneurysm size and morphology were assessed as well as the presence of arteriovenous fistula was excluded. Results: In the reported study, 94.8% (128/135) of patients were successfully treated during the initial thrombin injection. Additional 400 IU dose of thrombin after 24 hours was effective in 5 out of 7 patients with recanalization during the follow-up. A total of 98.5% (133/135) of patients were successfully treated with a percutaneous ultrasound-guided thrombin injection. Conclusions: The 10-year experience presented in this study as well as literature reports prove that percutaneous ultrasound-guided thrombin injection is an effective and safe treatment method for iatrogenic arterial access site pseudoaneurysm.

Safety evaluation of percutaneous ultrasound-guided thrombin injection into pseudoaneurysms

“…The treatment of pseudoaneurysm by ultrasound-guided thrombin injection is a highly effective method whose success rate is defined at 90-100% [2][3][4][5][6][7]. It has substituted other treatment methods: prolonged compression dressing, ultrasonographic probe compression, surgery.…”

Pseudoaneurysms of the Peripheral Arteries

“…1 Of those that recanalize after first successful UGTI, 71% had long term success with a second treatment with UGTI. 20 However, Khoury et al did report one pseudoaneurysm rupture after initially successful UGTI. 21 This modality can be used multiple times with success after the repeat administration.…”

“…1,3,14 However, Jargiełło et al, in their series of pseudoaneurysm treatments, did treat a small number of upper extremity pseudoaneurysms in the brachial and radial arteries with good success. 20 Generally, it is accepted that a reasonable neck, connection tract between the sac and source artery, needs to be present to perform UGTI. Yang et al had 100% success in treating femoral pseudoaneurysms.…”

Endovascular management of pelvic trauma

“…CT can be used to assist decision making and triage of patients who need angiography and embolization from those who do not (50). The identification of extravasation does not alone define the need for endovascular intervention (50,52,53) although higher overall mortality rates have been observed in patients with extravasation (53)(54)(55). Other factors to consider when deciding to pursue an endovascular course of treatment include hemodynamic instability, high transfusion needs and a direct relationship between extravasation and pelvic hematoma (50,52,53).…”

“…The options for treatment of a femoral pseudoaneurysm arising secondary to trauma or iatrogenic injury include manual compression in the first instance and if this is unsuccessful, ultrasound guided thrombin injection ( Figures 3 and 4 ) . Thrombin is injected into the pseudoaneurysm under ultrasound guidance and resolution of flow to the pseudoaneurysm sac can be assessed at the time of treatment which also determines the volume of thrombin injected (54). This has been shown to have a high success rate, reported between 91% and 100%, whilst complications are rare, with embolic events reported in 0.6% (55).…”