Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms.
BACKGROUND
This prospective study was designed to assess the safety and efficacy of using bovine thrombin injection to treat pseudoaneurysms.


RESULTS
From April 1998 through December 1999, 70 pseudoaneurysm were injected with bovine thrombin under the guidance of color duplex ultrasound. The most superficial pseudoaneurysm chamber was entered with a 1.5-inch, 19- to 22-gauge or spinal needle. Bovine thrombin, in a 1000 U/cc solution, was injected into the chamber. A total of 36 women and 34 men underwent ultrasound-guided thrombin injection (UGTI). Their mean age was 69.5 years. Most pseudoaneurysms were associated with diagnostic cardiac catheterization or percutaneous coronary intervention (80%). Two pseudoaneurysms arose from the brachial artery; the remainder were in the groin. Twenty-one patients were being treated with either heparin or warfarin, and the majority of the others were on antiplatelet therapy with aspirin or clopidogrel. UGTI was successful in 66 of the 70 patients (94%). The first patient in the series had 2 attempts at thrombin injection and refused further attempts. Two patients had undergone stent graft placement and had short, wide tracts. Both of these patients required surgical repair of their pseudoaneurysms. The fourth patient had a nearly complete pseudoaneurysm thrombosis and was lost to follow-up on discharge. No arterial thrombotic events occurred. One patient had a soleal vein thrombosis in the ipsilateral leg.


CONCLUSIONS
UGTI was safe and effective in 94% of patients with postcatheterization pseudoaneurysms. Anticoagulant use did not hinder successful thrombosis. UGTI should be the initial treatment of choice for patients with postcatheterization pseudoaneurysms.
La Perna
L
L
Departments of Vascular Medicine and Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Olin
J W
JW
Goines
D
D
Childs
M B
MB
Ouriel
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001916:Brachial Artery; D002404:Catheterization / Q000009:adverse effects*; D003331:Coronary Vessels; D005260:Female; D006119:Groin / Q000098:blood supply; D006490:Hemostatics / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011446:Prospective Studies; D013917:Thrombin / Q000008:administration & dosage* / Q000627:therapeutic use; D018615:Ultrasonography, Doppler, Color; D014859:Warfarin / Q000627:therapeutic use
D006490:Hemostatics; D014859:Warfarin; D013917:Thrombin