Percutaneous ultrasound-guided thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms.
OBJECTIVE
To audit our experience with ultrasound-guided thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms.


METHODS
A retrospective study of 85 consecutive patients undergoing percutaneous ultrasound-guided thrombin injection of post-catheterization femoral pseudoaneurysms during the period January 2002 to May 2007.


RESULTS
Pseudoaneurysms had a mean maximum diameter of 3.3 cm (range 1.0-7.6 cm) and a mean neck width of 3.4mm (range 1.0-7.0mm). No statistically significant correlation existed between maximum diameter and neck width (Kendall's rank correlation tau b=-0.09, p=0.5). The median dose of thrombin injected was 425 U (range 100-1500 U). The procedure resulted in complete sac thrombosis in 81 (95%) patients. Seventy-nine pseudoaneurysms thrombosed immediately after one injection, whereas two required a second thrombin injection. There were no procedural complications. The maximum diameter of the pseudoaneurysm was predictive of procedural success (Wilcoxon's rank sum test, p=0.001) and of the 5 patients with a pseudoaneurysm measuring ≥6 cm, ultrasound-guided thrombin injection was unsuccessful in 4 (4/5 versus 0/80, p<0.0001, Fisher's exact test). Three of these necessitated implantation of a stent-graft, whereas one required repeated thrombin injection and coil placement. In contrast, the pseudoaneurysm neck width did not seem to relate to the success of the procedure.


CONCLUSIONS
Percutaneous ultrasound-guided thrombin injection of is a quick, effective and safe treatment for iatrogenic femoral pseudoaneurysms. For larger pseudoaneurysms, although it is worth attempting more than one thrombin injection, endovascular repair may eventually be required.
Vlachou
Paraskevi A
PA
Department of Radiology, Leicester Royal Infirmary, Leicester, United Kingdom.
Karkos
Christos D
CD
Bains
Salena
S
McCarthy
Mark J
MJ
Fishwick
Guy
G
Bolia
Amman
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000187:drug effects; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D007269:Injections, Intra-Arterial / Q000379:methods; D008297:Male; D008875:Middle Aged; D013917:Thrombin / Q000008:administration & dosage*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult
D006490:Hemostatics; D013917:Thrombin