title: Safety and efficacy of a potential treatment algorithm by using manual compression repair and ultrasound-guided thrombin injection for the management of iatrogenic femoral artery pseudoaneurysm in a large patient cohort.
abstract: BACKGROUND
  Because of the risk of associated complications, femoral pseudoaneurysm (PSA) formation implies further treatment. Ultrasound-guided thrombin injection (UGTI) is becoming the accepted gold standard, but manual compression (MC) represents an established treatment option including PSAs not feasible for UGTI. This study aims to assess our experience in PSA treatment using MC or UGTI according to a potential algorithm based on morphological properties in a large patient cohort.
  
  
  RESULTS
  Between January 2007 and January 2011, a total of 432 PSAs were diagnosed in 29091 consecutive patients (1.49%) undergoing femoral artery catheterization. When compressible, small PSAs (<20 mm), PSAs without clearly definable neck, PSAs directly adjacent to vessels, and PSAs with concomitant arteriovenous fistula were referred to MC (n=145, 34%). All other PSAs were treated by UGTI (n=287, 66%). Follow-up duplex scans were performed within 12 to 14 hours after manual compression therapy and within 4 to 6 hours after UGTI or by the next morning and were available for 428 patients (99.1%). The overall success rate of our institutional therapeutic approach was 97.2%, which was achieved by 178 MC- and 357 UGTI-procedures, respectively. Procedural complications occurred in 5 cases (1.4%) after UGTI and in 3 cases (1.7%) after MC, respectively. The treatment algorithm was not successful in 12 patients, whereas 2 PSAs (0.5%) were successfully excluded by implantation of a covered stent-graft, and 10 patients necessitated surgical intervention (2.3%), which was associated with a high complication rate (30%).
  
  
  CONCLUSIONS
  The presented treatment algorithm facilitates effective and safe PSA elimination.
authors.affiliation: From the I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (M.D.-H., N.L., P.G., C. Bradaric, N.v.B., K.-L.L., T.I.); Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (M.L., C. Böttiger, R.A.B., B.S., T.K., J.G., M.H., I.O., A.K.); and DZKH (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (M.D.-H., N.L., P.G., C. Bradaric, M.L., C.Böttiger, R.A.B., B.S., T.K., J.G., M.H., I.O., N.v.B., A.K., K.-L.L., T.I.).
authors.forename: Marijana
authors.initials: M
authors.lastname: Dzijan-Horn
authors.forename: Nicolas
authors.initials: N
authors.lastname: Langwieser
authors.forename: Philipp
authors.initials: P
authors.lastname: Groha
authors.forename: Christian
authors.initials: C
authors.lastname: Bradaric
authors.forename: Maryam
authors.initials: M
authors.lastname: Linhardt
authors.forename: Corinna
authors.initials: C
authors.lastname: Böttiger
authors.forename: Robert A
authors.initials: RA
authors.lastname: Byrne
authors.forename: Birgit
authors.initials: B
authors.lastname: Steppich
authors.forename: Tobias
authors.initials: T
authors.lastname: Koppara
authors.forename: Julia
authors.initials: J
authors.lastname: Gödel
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
authors.forename: Ilka
authors.initials: I
authors.lastname: Ott
authors.forename: Nicolas
authors.initials: N
authors.lastname: von Beckerath
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.forename: Karl-Ludwig
authors.initials: KL
authors.lastname: Laugwitz
authors.forename: Tareq
authors.initials: T
authors.lastname: Ibrahim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D007269:Injections, Intra-Arterial; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*
chemical_list: D013917:Thrombin
keywords: algorithms; aneurysm, false