Treatment of arterial pseudoaneurysms with percutaneous ultrasound-guided thrombin injection.
BACKGROUND
The pseudoaneurysms or false aneurysms are one of the most common complications after arterial invasive manipulation. Different methods of treatment have been described, such as surgical repair, ultrasound-guided compression and endovascular procedures. Ultrasound-guided thrombin injection has shown efficacy, safety and  low cost, and, in some cases, the procedure is considered the treatment of choice. Preliminary results are presented.


METHODS



METHODS
Case series. We studied adult patients with iatrogenic arterial pseudoaneurysms demonstrated clinically and corroborated with ultrasound. We describe the technique used for the management of the arterial pseudoaneurysms by ultrasound-guided thrombin application, as well as complications and follow-up.


RESULTS
Twelve patients were included with a mean age of 63 years (SD 12.4), 33% were male and 67% female. Associated comorbid states were hypertension 83%, 50% diabetes, obesity 66%.  All pseudoaneurysms were located in the femoral artery (2:1 right/left ratio). The mean size of the pseudoaneurysm was 48.2 mm SD 11.9, (range of 30 to 65 mm) by 44.3 mm SD 9.3, (range 20 to 53 mm). The average neck diameter was 2.2 mm SD 0.54 (range of 1.5 to 3 mm). Eleven cases were unilobulated (87.5%), and one bilobulated (12.5%). All reported arterial integrity with complete occlusion after one thrombin application without recurrence and morbidity after 90 days of follow up.


CONCLUSIONS
In our study we obtained a 100% of thrombosis without pseudoaneurysm recurrence or complications. However a longer follow-up time and more number of cases are required to confirm these results.
Servicio de Angiología, Cirugía Vascular y Torácica. Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.
Manuel Alejandro
MA
Sánchez-Enciso
Cesar
C
Nuño-Escobar
Alejandro
A
González-Ojeda
Francisco Javier
FJ
Llamas-Macias
Carlos Rubén
CR
Ramos-López
Clotilde
C
Fuentes-Orozco
D017541:Aneurysm, False / Q000188:drug therapy*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D013917:Thrombin / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional
D015718:Fibrin Tissue Adhesive; D013917:Thrombin