[Minimally invasive percutaneous contrast-ultrasound guided thrombin occlusion of iatrogenic pseudoaneurysm].
BACKGROUND
Complicating femoral artery puncture aneurysms may occur resulting in the need for surgical or newer, non- or minimal-invasive therapy: A new minimal-invasive method is the percutaneous occlusion injecting bovine thrombin. The high thrombogenous potential of thrombin bears the risk of iatrogenic artery occlusion by artificial intravascular instillation.


OBJECTIVE
Is the contrast-ultrasound guided thrombin injection safe and effective in occluding femoral aneurysms?


METHODS
During 1/99 to 12/00, 33 femoral artery aneurysms as a complication coronary catheterization were diagnosed. In 32 patients the aneurysm (mean dimensions 32 x 35 x 24 mm) was punctured during ultrasound guidance. By injecting ultrasound contrast medium, the flow pattern perfusing the aneurysm was documented. In the canula position where no contrast medium exited the aneurysm thrombin was injected.


RESULTS
Complete occlusion of the aneurysm was achieved in 96.9% (31 out of 32) of the patients by contrast-ultrasound guided thrombin occlusion. Follow-up for up to 3 months after the procedure revealed complete occlusion and no clinical or sonographical complications. In one case, a large aneurysm (50 mm x 62 mm x 27 mm) had already led to skin alterations and was only partly occluded by thrombin injection.


CONCLUSIONS
Contrast-ultrasound guided thrombin occlusion of femoral artery aneurysms is safe and highly effective.
Grewe
P H
PH
Abteilung für Kardiologie und Angiologie Berufsgenossenschaftliche Kliniken Bergmannsheil Bochum Universitätsklinik Bürkle-de-la-Camp-Platz 1 44789 Bochum, Germany. PeterGrewe@AOL.com
Deneke
T
T
Fadgyas
T
T
Germing
A
A
Lemke
B
B
Müller
K M
KM
von Dryander
S
S
D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D000818:Animals; D002417:Cattle; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D011134:Polysaccharides; D013917:Thrombin / Q000008:administration & dosage*; D018615:Ultrasonography, Doppler, Color
D003287:Contrast Media; D006490:Hemostatics; D011134:Polysaccharides; C040642:SHU 454; D013917:Thrombin