A prospective study on ultrasound-guided compression therapy or thrombin injection for treatment of iatrogenic false aneurysms in patients receiving full-dose anti-platelet therapy.
BACKGROUND
False aneurysms (FA) develop at the puncture site in up to 6% of percutaneous cardiovascular procedures. Previous management included surgery or manual compression. Recently, selective injection of thrombin has been proposed as an alternative. However, there has been no direct comparison of thrombin injection to manual compression.


OBJECTIVE
To study the effectiveness of manual compression compared to that of thrombin injection in patients with false aneurysms on full-dose aspirin and clopidogrel. METHODS AND PROTOCOL: All patients with a clinically suspected FA after percutaneous invasive procedures were recruited for the study. The patients were examined with color ultrasound (7.5 MHz transducer). The minimum and maximum diameters of the false aneurysm and the distance between the surface and the false aneurysm were measured online. Under local anesthesia, manual compression was applied under sonographic guidance in all patients. If compression stopped flow into the false aneurysm, manual compression was applied for a maximum of 40 min followed by compression bandage for a minimum of 12 hours. If compression failed, thrombin was injected under ultrasound guidance.


RESULTS
Thirty-six patients had a FA. Their age ranged from 58 to 90 years (mean 71+/-9 years). All patients were taking aspirin (median dose 100 mg per day) and clopidogrel (median dose 75 mg per day). Additionally, 24 patients had received subcutaneous heparin (7500 to 12 500 units) or enoxaprin (0.4-1.0 ml) 3 to 12 hours before treatment. The mean width of the false aneurysm was 22.1+/-3 mm, mean length 33.6+/-35.4 mm, and mean depth 19.5+/-8.2 mm. In six patients (17%), ultrasound-guided manual compression was tolerated, succeeding after 5 to 31 minutes. Thirty patients received thrombin injections (100-1800 units, mean 880+/-470 units, median 800 units). Complete thrombosis occurred in 28 patients (93%). Surgery was performed in the other two patients. The thrombin injection was not associated with any complications. In particular, there were no peripheral vascular complications.


CONCLUSIONS
In patients with FA taking aspirin and clopidogrel, selective thrombin injection is more effective than manual compression.
Görge
G
G
Medizinische Klinik II, Klinikum Saarbrücken, Winterberg 1, 66119 Saarbrücken, Germany. g.gorge@mx.uni-saarland.de
Kunz
T
T
Kirstein
M
M
D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D000077144:Clopidogrel; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries; D006801:Humans; D007049:Iatrogenic Disease; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011312:Pressure; D011446:Prospective Studies; D013917:Thrombin / Q000008:administration & dosage*; D013988:Ticlopidine / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014159:Transducers; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013917:Thrombin; D013988:Ticlopidine; D001241:Aspirin