[Application of the percutaneuos thrombin injection in treatment of iatrogenic femoral pseudoaneurysms].
Pseudoaneurysms are not a common complication of the endovascular procedures but can present a serious therapeutic problem. Both, the application of compression therapy and surgical operation can lead to the development of subsequent complications. The aim of this study was analysis of the treatment results of iatrogenic pseudoaneurysms managed with percutaneous thrombin injection. Treated group consisted of 69 patients diagnosed with iatrogenic femoral pseudoaneurysms. The indication for injection technique was ineffective compression therapy as well as necrotic changes or bacterial skin infection in the groin area or a large diameter of pseudoanurysm's chambers. Thrombin was injected percutaneously during 1-3 sessions in the dose of 100-1200 U into the centre of the chamber under ultrasound control. Primary and secondary success rate was 88% and 94% respectively. The following factors significantly decreased effectiveness of the method: complex pseudoaneurysms (with treatment efficacy 82% and 88% respectively vs 90% and 96% for simple pseudoaneurysms), and large chamber volume. Early and late recanalization of the thrombotic changes appeared in 7% and 3% of treated cases. The most frequent complication was appearance of non-elastic tumor (71%) or pain (64%) in the groin area. The most serious complication was acute lower limb ischemia detected in one case (2%) as a result of femoral artery compression by the thrombosed pseudoaneurysm. Percutaneous thrombin injection should be a preferred method of pseudoaneurysms treatment, especially in cases of ineffective compression therapy or its contraindications due to low cost of the therapy, simplicity of the technique and relatively low percentage of the complications.
Gabriel
Marcin
M
Klinika Chirurgii Ogólnej i Naczyń Uniwersytetu Medycznego w Poznaniu. mgabriel@pro.onet.pl
Pawlaczyk
Katarzyna
K
Krasński
Zbigniew
Z
Pukacki
Fryderyk
F
Brzeziński
Jacek
J
Zieliński
Maciej
M
Noman
Dawod M
DM
Nowak
Marek
M
Majewski
Wacław
W
D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D013917:Thrombin / Q000008:administration & dosage*; D016896:Treatment Outcome; D014463:Ultrasonography
D006490:Hemostatics; D013917:Thrombin