title: Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients.
abstract: OBJECTIVE
  To prospectively evaluate ultrasonographically (US) guided percutaneous thrombin injection for treatment of femoral artery and brachial artery pseudoaneurysms.
  
  
  METHODS
  The university institutional review board approved the study. Informed consent was obtained from all patients. Two hundred forty patients with postcatheterization femoral artery (n = 132) or brachial artery (n = 8) pseudoaneurysms were treated with US-guided bovine thrombin (1.000 IU/mL) injection. At diagnosis, 107 (44.6%) patients received anticoagulation therapy; 159 (66.2%), antiplatelet therapy; and 76 (31.7%), both therapies. Pseudoaneurysm size, length and width of pseudoaneurysm neck, thrombin dose, therapy outcome, and complications were documented. The peak blood flow in peripheral arteries was determined before and after thrombin injection. Follow-up duplex US was performed 12-24 hours, 5-7 days, and 21-25 days after treatment. A nonpaired t test was used to compare differences in age between the male and female patients. Two-way analysis of covariance was performed to analyze the influences of factors that may have been related to the amount of thrombin used.
  
  
  RESULTS
  Mean pseudoaneurysm volume was 4.69 cm3 +/- 5.49 (standard deviation). Simple and complex pseudoaneurysms were treated in 165 and 75 patients, respectively. A total of 260 thrombin injections were performed: 1.04 injections per patient with a simple pseudoaneurysm and 1.17 injections per patient with a complex pseudoaneurysm. The mean injected thrombin dose was 425.31 IU +/- 341.75 for all pseudoaneurysms, 382.12 IU +/- 281.00 for simple pseudoaneurysms only, and 520.33 IU +/- 434.64 for complex pseudoaneurysms only. There was only a computational correlation between pseudoaneurysm size and thrombin dose (r2 = 0.07). The primary success rate was 93.8% overall, 95.8% for simple pseudoaneurysms, and 89% for complex pseudoaneurysms. The secondary success rate was 99.6% overall, 100% for simple pseudoaneurysms, and 99% for complex pseudoaneurysms. Early (at < or =24 hours) reperfusion occurred in one simple and five complex pseudoaneurysms. Four late reperfusions-two in simple and two in complex pseudoaneurysms-were detected at 1-week follow-up; no late reperfusions were detected at 3 weeks. Thromboembolic complications occurred in two patients and resolved spontaneously. One mild allergic reaction and no infections occurred.
  
  
  CONCLUSIONS
  US-guided percutaneous thrombin injection enables successful, safe management of postcatheterization pseudoaneurysms.
authors.affiliation: Department of Radiology and Institute for Medical Statistics, Informatics and Epidemiology, University of Cologne, Joseph-Stelzmann-Str, 50924 Cologne, Germany. Karsten.Krueger@uni-koeln.de
authors.forename: Karsten
authors.initials: K
authors.lastname: Krueger
authors.forename: Markus
authors.initials: M
authors.lastname: Zaehringer
authors.forename: David
authors.initials: D
authors.lastname: Strohe
authors.forename: Hartmut
authors.initials: H
authors.lastname: Stuetzer
authors.forename: Julia
authors.initials: J
authors.lastname: Boecker
authors.forename: Klaus
authors.initials: K
authors.lastname: Lackner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017541:Aneurysm, False / Q000188:drug therapy* / Q000209:etiology*; D001916:Brachial Artery; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use*; D018084:Ultrasonography, Interventional
chemical_list: D013917:Thrombin