Ultrasound guided human thrombin injection. A new modality in the management of femoral artery pseudo-aneurysms.
OBJECTIVE
We report our initial results of a prospective study of duplex ultrasound-guided injection (UGTI ) of thrombin in the management of femoral artery pseudo-aneurysms. We used human thrombin to avoid the increase in the human antibodies directed against fibrinogen, with the use of bovine thrombus, that preclude further utilisation of the bovine fibrin glue during cardio-thoracic surgery.


METHODS
From 1999 to 2001, 19 patients, aged 69 (range 52-85) years presented with 21 femoral pseudo-aneurysms were treated. The mean pseudoaneurysm diameter was 30 (15-55) mm. All but two were secondary to cardiac procedures and the common femoral artery was the injured vessel in all instances. Patients were referred within 2-21 days following their iatrogenic injury.


RESULTS
Immediate thrombosis of the sac occurred in 19 (90%) of the 21 pseudo-aneurysms. After a second injection, complete occlusion occurred in the remaining two patients. Two patients (CI 95%; 1-19) with three femoral pseudo-aneurysms developed leg pain. Duplex ultrasound follow-up showed two recurrences (9.5% - CI 95%; 1-19) and both were treated by repeat UGTI. There was no conversion to surgical repair.


CONCLUSIONS
This percutaneous minimally invasive technique is safe and effective in the management of iatrogenic pseudo-aneurysms in this high-risk group of patients. Human thrombin has significant advantages over bovine thrombin.
Sultan
S
S
St. James's Vascular Institute, St. James's Hospital, Trinity College, Dublin 8, Ireland.
Nicholls
S
S
Madhavan
P
P
Colgan
M P
MP
Moore
D
D
Shanik
G
G
D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D003029:Coagulants / Q000008:administration & dosage*; D005260:Female; D005263:Femoral Artery / Q000293:injuries; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D013917:Thrombin / Q000008:administration & dosage*; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional
D003029:Coagulants; D013917:Thrombin