title: Cardiologist operated ultrasound guided thrombin injection as a safe and efficacious first line treatment for iatrogenic femoral artery pseudoaneurysms.
abstract: OBJECTIVE
  To assess the efficacy and safety of ultrasound guided thrombin injection (UGTI) as a first line treatment for post arterial cannulation iatrogenic femoral artery pseudoaneurysms (IFAP).
  
  
  BACKGROUND
  IFAPs complicate up to 1% of diagnostic and 8% of interventional cardiac catheterisation procedures. UGTI remains a second line or non-attempted treatment after ultrasound guided manual compression (UGMC) and surgical repair in many centres.
  
  
  METHODS
  A retrospective review was undertaken of 121 consecutive patients who received UGTI as a first line treatment for IFAPs following cardiac diagnostic, interventional or catheter ablation procedures between 1999 and 2011 at our centre. The mean patient age was 70.7 years and 63% were male. At the time of injection, 89% were on at least one antiplatelet or anticoagulant. Pseudoaneurysms had a mean maximum dimension of 26.7mm (range 10-122mm) and 25% were multilobed. UGTI was performed by an interventional cardiologist with a mean bovine thrombin dose of 648 IU (range 50-5000 IU).
  
  
  RESULTS
  Primary success, defined as immediate IFAP thrombosis with UGTI, was achieved in 111 (92%) patients. Recurrence occurred in seven patients, three of whom required surgical repair. Multilobed IFAPs had significantly lower primary success rates than unilobed IFAPs (80% vs. 96%, p=0.016). Antiplatelet and anticoagulant use and IFAP size did not significantly affect outcomes. UGTI was not associated with any serious complications (such as thromboembolism, aneurysm rupture, venous thrombosis or abscess formation).
  
  
  CONCLUSIONS
  Interventional cardiologist operated UGTI should be considered as a first line therapy for uncomplicated IFAPs following interventional and diagnostic cardiac procedures. Despite high rates of concomitant antiplatelet and antithrombotic therapy, initial thrombosis rates exceeded 90% and we did not experience serious complications.
authors.affiliation: Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia. Electronic address: dhdchen@gmail.com.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Chen
authors.affiliation: Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia; Prince of Wales Clinical School, University of New South Wales, Australia.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Sammel
authors.affiliation: Royal North Shore Hospital, Australia.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Jain
authors.affiliation: Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia; Prince of Wales Clinical School, University of New South Wales, Australia.
authors.forename: Nigel S
authors.initials: NS
authors.lastname: Jepson
mesh_terms: 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*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013917:Thrombin / Q000008:administration & dosage*; D014463:Ultrasonography
chemical_list: D006490:Hemostatics; D013917:Thrombin
keywords: Cardiac Catheterisation; Doppler; Duplex; Pseudoaneurysm; Thrombin; Ultrasonography