title: Femoral pseudoaneurysms: management with percutaneous thrombin injections--success rates and effects on systemic coagulation.
abstract: OBJECTIVE
  To determine the success rate of percutaneous ultrasonographically (US) guided thrombin injection in the treatment of femoral pseudoaneurysms and to evaluate the effects of thrombin injection on systemic coagulation parameters.
  
  
  METHODS
  Fifty femoral pseudoaneurysms (37 simple pseudoaneurysms with one lobe and 13 complex pseudoaneurysms with two or three lobes) were treated with US-guided percutaneous thrombin injections. Pseudoaneurysm size, neck length and width, thrombin dose, outcome of therapy, and complications were documented prospectively. Duplex sonographic follow-up examinations were performed at 12-24 hours and 5-7 and 21-25 days. In 25 patients, activated thromboplastin time, Quick test (prothrombin time), thrombin time, fibrinogen, D-dimer, antithrombin III, thrombin-antithrombin III complex, and prothrombin fragments 1 and 2 were determined before and at 2, 5, and 10 minutes after thrombin injection. Differences in results before and those after thrombin injection were evaluated by means of the one-sample t test.
  
  
  RESULTS
  Mean volume of pseudoaneurysms was 5.84 cm(3) +/- 4.89 (SD). Fifty-eight thrombin injections were performed. Mean thrombin dose was 357 IU +/- 291 in simple and 638 IU +/- 549 in complex pseudoaneurysms. Primary success rate was 36 of 37 (97%) for simple and eight of 13 (61%) for complex pseudoaneurysms. Reperfusion occurred in four complex pseudoaneurysms (none in simple ones). Secondary success rate was 100%. No thromboembolic, infectious, or allergic complications occurred. During follow-up, reperfusion was detected in one patient with a complex pseudoaneurysm. Levels of thrombin-antithrombin III complex increased significantly (P <.05) after thrombin injection, whereas changes in all other laboratory tests were not significant.
  
  
  CONCLUSIONS
  US-guided percutaneous injection of thrombin is successful and safe in the management of femoral pseudoaneurysms. The increase of thrombin-antithrombin III complex indicates the possibility of thrombin passage into the arterial circulation.
authors.affiliation: Department of Radiology, University of Cologne, Joseph-Stelzmann-Strasse, D-50924 Cologne, Germany. karsten.krueger@uni-koeln.de
authors.forename: Karsten
authors.initials: K
authors.lastname: Krüger
authors.forename: Markus
authors.initials: M
authors.lastname: Zähringer
authors.forename: Franz-Dietmar
authors.initials: FD
authors.lastname: Söhngen
authors.forename: Axel
authors.initials: A
authors.lastname: Gossmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Schulte
authors.forename: Christoph
authors.initials: C
authors.lastname: Feldmann
authors.forename: David
authors.initials: D
authors.lastname: Strohe
authors.forename: Klaus
authors.initials: K
authors.lastname: Lackner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001780:Blood Coagulation Tests; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013917:Thrombin / Q000008:administration & dosage*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional
chemical_list: D013917:Thrombin