Percutaneous injection of thrombin for the treatment of pseudoaneurysms after catheterization: an alternative to sonographically guided compression.
OBJECTIVE
The purpose of our study was to determine the efficacy of percutaneous thrombin treatment for iatrogenic pseudoaneurysms of the femoral artery in comparison with sonographically guided compression repair.


METHODS
Twenty-three pseudoaneurysms occurring after catheterization were treated percutaneously with an initial injection of 1.0 mL of thrombin solution via a 22-gauge spinal needle under continuous sonographic guidance. Four patients required the additional injection of 1.0-4.0 mL of thrombin for complete thrombosis. Repeated sonography was performed 24 hr after injection. Additionally, we compared our results with those of a control group by reviewing the imaging findings and medical records of 16 patients who underwent sonographically guided compression of iatrogenic pseudoaneurysms between January 1998 and July 1998.


RESULTS
Twenty-two of 23 pseudoaneurysms occurring after catheterization were successfully treated with percutaneous thrombin injection. One recurrence was identified 24 hr after injection in a patient who experienced a significant complication. Procedure time was limited to 15 min with an overall success rate of 96%. Retrospectively, 18 iatrogenic pseudoaneurysms were identified in 16 patients. Six (60%) of 10 pseudoaneurysms were successfully compressed under sonographic guidance, with an average time to thrombosis of 32 min. Compression was unsuccessful for four pseudoaneurysms with an average compression time of 45 min. Compression could not be performed in seven patients (39%). The overall success rate of sonographically guided repair was 60%.


CONCLUSIONS
Preliminary evidence suggests that sonographically guided percutaneous thrombin injection is a safe and effective method of treatment for iatrogenic pseudoaneurysms and offers significant advantages over conventional sonographically guided compression.
Pezzullo
J A
JA
Department of Diagnostic Imaging, Brown University School of Medicine and Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA.
Dupuy
D E
DE
Cronan
J J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D006328:Cardiac Catheterization; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012189:Retrospective Studies; D013917:Thrombin / Q000008:administration & dosage*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D013917:Thrombin