Occlusion of postcatheterisation femoral pseudoaneurysms with percutaneous thrombin injection under ultrasound guidance.
OBJECTIVE
The incidence of iatrogenic femoral artery pseudoaneurysms is reported to occur in 1-7% by of all percutaneous catheterisations. These pseudoaneurysms are traditionally treated by ultrasound-guided compression or surgical repair. We report our experience in sealing postcatheterization femoral pseudoaneurysms with percutaneous thrombin injection under colour-Doppler ultrasound guidance.


METHODS
Since June 2000 we have consecutively treated 31 pseudoaneurysms in 30 patients, (14 males and 16 females, age range 45 to 81 years); in one patient the pseudoaneurysm was bilateral. All patients had a clinical diagnosis of postcatheterization femoral pseudoaneurysm, later confirmed by colour-Doppler ultrasonography. We injected a bovine thrombin solution percutaneously at a concentration of 1000 U/mL using 21-22 gauge needles under colour Doppler ultrasound guidance. All patients underwent clinical and colour-Doppler US examination before, during and 24 hours after the procedure and were followed up after 1 and 3 months.


RESULTS
The primary success rate was 83.8%. Complete and persistent occlusion of the pseudoaneurysm was achieved in less than 20 seconds by administering an average dose of 880 U of thrombin (0.8 mL of solution). In 5 cases (16.1%) reperfusion of the pseudoaneurysm was observed within 24 hours. These patients underwent a repeat procedure. The final result was successful in 96.7% of patients (30 of 31 cases). No thromboembolic complication was observed. Only 22.5% of patients reported a heat sensation in the treated limb, which resolved spontaneously within minutes.


CONCLUSIONS
The percutaneous injection of thrombin under ultrasound colour-Doppler guidance should be regarded as the first choice treatment for postcatheterization femoral pseudoaneurysms, owing to its simplicity, safety, effectiveness and inexpensiveness.
Corso
Rocco
R
Radiologia Diagnostica ed Interventistica, Ospedale Niguarda Cà Granda, Milano, Italy. roccocorso@jumpy.it
Rampoldi
Antonio
A
Riolo
Franco
F
Carrafiello
Gianpaolo
G
Solcia
Marco
M
Intotero
Marcello
M
Vanzulli
Angelo
A
D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D013917:Thrombin / Q000008:administration & dosage*; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional
D013917:Thrombin