Treatment options for post-catheterisation femoral pseudoaneurysm closure.
BACKGROUND
Femoral artery pseudoaneurysm (FAP) complicates from 1% to 9% of all coronary angiography procedures and contributes to extended hospitalisation as well as patient discomfort.


OBJECTIVE
To compare three main methods of FAP closure which are used nowadays.


METHODS
Seventy-five subjects (38 females, 37 males, mean age 60.8+/-10.4 years) with post-catheterisation FAP were studied. The results of three methods of FAP closure--surgical, local compression and thrombin injection--were compared.


RESULTS
Between September 2000 and July 2001, fourteen patients developed FAP; in 9 (64%) patients FAP was closed with repeated prolonged compression whereas the remaining 5 (36%) patients required surgical closure of compression-resistant FAP. We observed that FAPs with longer neck (>10 mm) and primary signs of partial spontaneous coagulation were more prone to self-closure as compared to FAPs with short neck and no signs of perimural coagulation (p=0.01). Since July 2001, we introduced ultrasound-guided thrombin injection into FAP sack. The protocol included attempt of closing FAP with probe compression and compression dressing put overnight, and, if unsuccessful, followed by a quick injection of 2 ml of thrombin solution (400-3200 U), guided by ultrasound. During this period, we identified 61 patients with FAP. Out of this group, 5 (8.2%) subjects were referred for surgery without any attempt of thrombin-injection, in 16 (26.2%) patients FAP was closed with probe compression and dressing put overnight, and in the remaining 40 (65.6%) subjects ultrasound-guided thrombin-injection was performed. Thrombin injection into FAP sack caused closure of its cavity and neck in all patients, however, five patients required additional thrombin injection during the same session, and 2 (5.0%) patients--during the next procedure. No peri-procedural complications were observed. The duration of hospital stay shortened from a mean of 26.6+/-14.5 days in surgically treated patients to 7.9+/-6.7 in those in whom FAPs were closed with compression, and to 4.6+/-2.6 days in those treated with thrombin (p<0.001). During a mean follow-up of 11+/-8.1 months, we re-examined 32 (80.0%) patients in whom FAP was closed with thrombin injection. No long-term thrombotic or embolic complications were observed. However, in 2 (6.3%) patients FAP cavity did not undergo complete resorption after 6 and 12 months of follow-up.


CONCLUSIONS
Thrombin-induced closure of femoral pseudoaneurysm is a quick, safe and effective method, shortening hospitalisation time. In our Department this procedure replaced the prolonged and painful compression method.
Kabłak-Ziembicka
Anna
A
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Collegium Medicum, Jagiellonian University of Craców, ul. Pradnicka 80, 31-202 Craców, Poland.
Przewłocki
Tadeusz
T
Płazak
Wojciech
W
Podolec
Piotr
P
Stopa
Ireneusz
I
Kozanecki
Artur
A
Tracz
Wiesława
W
D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D017023:Coronary Angiography / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013917:Thrombin / Q000627:therapeutic use*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014656:Vascular Surgical Procedures / Q000379:methods*
D006490:Hemostatics; D013917:Thrombin