Compression repair versus low-dose thrombin injection for the treatment of iatrogenic femoral pseudoaneurysm: a retrospective case-control study.
BACKGROUND
It has been shown that thrombin injection is a safe and effective technique for the treatment of iatrogenic femoral pseudoaneurysm. The aim of this study was to evaluate and compare the use of ultrasound-guided low-dose thrombin injections with ultrasonographically-guided compression repair in the treatment of iatrogenic femoral arterial pseudoaneurysm.


METHODS
We compared two cohorts of patients treated for iatrogenic femoral pseudoaneurysm: the first included 38 patients who underwent ultrasonographically-guided compression repair as a first-step approach between January 1998 and November 2002; the second included 21 patients treated with ultrasound-guided low-dose thrombin injection between December 2002 and December 2003.


RESULTS
Both groups had similar demographic characteristics and aneurysm sizes (p = 0.72). Compression was successful in 24/38 patients (63%); the 14 persistent aneurysms were surgically repaired (37%). The primary thrombin injection of a mean dose of 185+/-95 U/ml (range 100-400 U/ml) successfully obliterated all of the 21 pseudoaneurysms (success rate 100 vs 63% in the compression group, p = 0.004). Thrombosis occurred within an average of 12+/-15 s of thrombin injection. Sedation was used in 42% of the patients undergoing compression and in none of those receiving thrombin (p = 0.001). The duration of hospitalization was significantly longer in patients undergoing compression therapy (9.8+/-5.6 vs 5.6+/-1.4 days, p = 0.001).


CONCLUSIONS
Ultrasound-guided low-dose thrombin injection appears to be more effective in reducing the need for surgical repair when used to treat iatrogenic femoral pseudoaneurysm, is better tolerated by the patients, and requires a shorter hospital stay.
Danzi
Gian Battista
GB
Poliambulanza Hospital, Brescia, Italy. gbdanzi@tin.it
Sesana
Marco
M
Capuano
Cinzia
C
Baglini
Roberto
R
Bellosta
Raffaello
R
Luzzani
Luca
L
Carugati
Claudio
C
Sarcina
Antonio
A
D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007049:Iatrogenic Disease; D007269:Injections, Intra-Arterial; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011312:Pressure; D012189:Retrospective Studies; D013917:Thrombin / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional
D006490:Hemostatics; D013917:Thrombin