title: Transcatheter "thrombin-blood patch" injection: a novel and effective approach to treat catheterization-related arterial perforation.
abstract: OBJECTIVE
  This study aimed to describe the safety and feasibility of transcatheter "thrombin-blood patch" (TBP) injection to treat catheterization-related arterial vascular access perforation.
  
  
  BACKGROUND
  Vascular access complications are infrequent but potentially life threatening conditions related to percutaneous procedures. Surgical vascular repair are associated with high rates of morbidity and mortality due to advanced cardiovascular disease.
  
  
  METHODS
  From October 2007 to July 2010 we studied 23 patients who presented active access arterial bleeding after percutaneous procedures and underwent transcatheter angiographic guided TBP injection across the entry site of the arterial perforation as a primary approach.
  
  
  RESULTS
  The mean age of the population was 67 years, predominantly female (78.3%) with high rate of comorbidities including diabetes (30.4%), prior coronary revascularization (50.0%), chronic renal failure (43.5%), and heart failure (56.5%). Thirteen patients (56.5%) developed severe hypotension after the index procedure. The repair procedure had a mean duration of 82 ± 57 minutes. TBP was injected in all patients. One case additionally required covered-stent to obtain hemostasis. Angiographic success was achieved in the 23 patients; however, one case required a second intervention due to recurrent bleeding, which was effectively treated using covered-stent. All patients were discharged alive and no major cardiovascular events, including myocardial infarction/stroke, were observed.
  
  
  CONCLUSIONS
  Transcatheter "thrombin-blood patch" injection is a safe, novel technique that allows prompt percutaneous approach to treat catheterization-related arterial perforation. This strategy appears particularly attractive to treat patients who cannot tolerate "open" vascular reconstruction and repair.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Washington Hospital Center, Washington, District of Columbia 20010, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Maluenda
authors.forename: Lavinia
authors.initials: L
authors.lastname: Mitulescu
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sardi
authors.forename: Rafael
authors.initials: R
authors.lastname: Romaguera
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Nelson L
authors.initials: NL
authors.lastname: Bernardo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects*; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011677:Punctures; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D013917:Thrombin / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013917:Thrombin