Ultrasound-Guided Thrombin Injection Is a Safe and Effective Treatment for Femoral Artery Pseudoaneurysm in the Morbidly Obese

Abstract

Introduction Ultrasound guided thrombin injection (UGTI) is a well-established practice for treatment of femoral artery pseudoaneurysm. This procedure is highly successful but dependent on appropriate pseudoaneurysm anatomy and adequate ultrasound visualization. Morbid obesity can present a significant technical challenge due to increased groin adiposity, resulting in poor visualization of critical structures needed to safely perform the procedure. We aim to evaluate the safety and efficacy of UGTI to treat femoral artery pseudoaneurysm in the morbidly obese. Methods This is a retrospective cohort study in which all patients who underwent UGTI at The Ohio State University Ross Heart Hospital from 2009 to 2014 were analyzed for patient characteristics and stratified by body mass index (BMI). Patients with BMI ≥ 35 were considered morbidly obese and were compared to patients with a BMI < 35. Outcome was failed treatment resulting in residual pseudoaneurysm. Results Our cohort consisted of 54 patients who underwent thrombin injection. There were 41 non-morbidly obese, and 13 morbidly obese patients. Mean age was 64.5 years. The cohort was 44.4% male. There were 6 failures of which 1 underwent successful repeat injection, and 5 underwent open surgical repair. There was no statistically significant difference in failure between non-morbidly obese, and morbidly obese patients (9.8% vs. 15.4%, p=0.45). There were no embolic/thrombotic complications. Conclusion UGTI is a safe and effective therapy in the morbidly obese for the treatment of femoral artery pseudoaneurysm. In the hands of experienced sonographers and surgeons with adequate visualization of the pseudoaneurysm sac, ultrasound guided thrombin injection should remain standard therapy in the morbidly obese.

Surgical treatment of iatrogenic pseudoaneurysms

“…[8,12] Successful rate of thrombin injection has been reported as 86 to 92%. [13] Additionally, thrombin injections may cause anaphylactic shock, pruritus, femoral artery thrombosis or embolism, femoral vein thrombosis, or infection within the aneurysm sac. [14] Rarely, prion injections may cause chronic degenerative brain disease, as thrombin is of bovine origin.…”

Ultrasound-Guided Fibrin Glue Injection for Treatment of Iatrogenic Femoral Pseudoaneurysms

“…9 -12 Ultrasound-guided thrombin injection is the current standard of treatment for iatrogenic PSA at many institutions with published high success rates ranging from 89% to 100%, and however, potential complications such as distal embolization and thrombosis of the artery or vein. 10,13 -15…”

Salvage of autogenous dialysis access with balloon-assisted thrombin injection

“…[1][2][3] An alternative to endovascular stent graft placement for PSA management is ultrasoundguided thrombin injection (UGTI). While successful use of UGTI to treat PSAs has largely been discussed in the context of femoral pseudoaneurysms, [4][5][6] several reports have also demonstrated its utility in autogenous dialysis access PSAs. [7][8][9] Like stent placement, UGTI is a minimally invasive approach to fistula PSA management; however, it offers the additional advantage of preserving the autogenous fistula without requiring the placement of prosthetic material.…”