The recurrence of iatrogenic femoral artery pseudoaneurysm after occlusion by ultrasound guided percutaneous thrombin injection.
OBJECTIVE
To evaluate efficacy of percutaneous ultrasound-guided thrombin injection (UGTI) of iatrogenic femoral artery pseudoaneurysm (PSA) and to identify the risk factors associated with PSA recurrence.


RESULTS
We treated 140 patients aged 76 years (range 49-83) presented with femoral artery PSA after cardiac catheterisation by percutaneous UGTI (500 IU/ml solution of activated human thrombin). Factors associated with the recurrence of PSA were analysed. One hundred nineteen patients were successfully treated by one injection of thrombin (immediate success rate 85%). In 19 patients (13.6%), short local compression following injection was needed for complete occlusion (overall success rate 98.6%, 138/140). In one case, progression of PSA required conversion to surgery (0.7%). In one patient with pre-existing stenosis of superficial femoral artery, acute limb ischaemia developed after UGTI (0.7%). The recurrence of PSA in 30-days follow-up (10 patients, 7%) was associated with obesity (BMI>30, OR=1.39, 95% CI 1.09-1.78, p<0.05), and with extensive combination of anti-aggregation and anti-coagulation therapy (OR=2.11, 95% CI 1.23-3.62, p<0.0001) as revealed by both univariate and multivariate analysis.


CONCLUSIONS
The UGTI is a safe and effective treatment of iatrogenic femoral artery PSA. Recurrence is low and associated with obesity and extensive use of combined anti-aggregation and anti-coagulation therapy.
Madaric
Juraj
J
National Cardiovascular Institute, Bratislava, Slovak Republic. jurmad@hotmail.com
Mistrik
Augustin
A
Vulev
Ivan
I
Liska
Branislav
B
Vozar
Matej
M
Lederer
Peter
P
Gocar
Martin
M
Kozlovska
Terezia
T
Fridrich
Viliam
V
De Bruyne
Bernard
B
Bartunek
Jozef
J
D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000453:epidemiology; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007049:Iatrogenic Disease / Q000453:epidemiology; D015994:Incidence; D007267:Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D012008:Recurrence; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use*; D014463:Ultrasonography
D013917:Thrombin