title: Ultrasound Guided Compression Versus Ultrasound Guided Thrombin Injection for the Treatment of Post-Catheterization Femoral Pseudoaneurysms: Systematic Review and Meta-Analysis of Comparative Studies.
abstract: OBJECTIVE
  To compare results of ultrasound based techniques (ultrasound guided compression-(UGC) versus ultrasound guided thrombin injection (UGTI)) to treat iatrogenic post-catheterization femoral pseudoaneurysms.
  
  
  METHODS
  The study design involved a systematic review of the literature and meta-analysis of comparative studies. The MEDLINE, CENTRAL, and OpenGray databases were searched up to October 2015. Primary outcome measure was efficacy, while other outcomes examined were safety (complication rate), duration of the procedure, length of hospitalization, and cost of methods. The random effects model was used to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI).
  
  
  RESULTS
  Two randomized control trials and 11 observational studies were included in the analysis. Overall, 786 and 318 subjects underwent UGC and UGTI respectively. The latter modality resulted in a significantly higher success rate (97.4% vs. 69.3%, OR 0.06, 95% CI 0.03-0.11) while the complication rate for both techniques was very low (0.69% vs. 0.78%, OR 1.77, 95% CI 0.40-7.88). Data regarding procedural duration and length of hospitalization were very scarce, favoring UGTI (procedural time: MD 35.53 min, 9.11-63.95, length of hospitalization MD 1.99 days, -0.31-4.29). Scarcity of data did not allow proper cost analysis, but two studies suggested that UGTI may offer reduced treatment costs.
  
  
  CONCLUSIONS
  Available evidence suggests that UGTI is superior in terms of efficacy and as safe as UGC and thus should be used as the primary modality for the treatment of post-catheterization femoral pseudoaneurysms.
authors.affiliation: Vascular Surgery Unit, University of Crete Medical School, University Hospital of Heraklion, Crete, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Kontopodis
authors.affiliation: Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Tsetis
authors.affiliation: Vascular Surgery Unit, University of Crete Medical School, University Hospital of Heraklion, Crete, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Tavlas
authors.affiliation: Vascular Surgery Department, Red Cross Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Dedes
authors.affiliation: Vascular Surgery Unit, University of Crete Medical School, University Hospital of Heraklion, Crete, Greece. Electronic address: ioannou@med.uoc.gr.
authors.forename: C V
authors.initials: CV
authors.lastname: Ioannou
mesh_terms: D002404:Catheterization / Q000379:methods; D016208:Databases, Factual; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D013917:Thrombin / Q000008:administration & dosage* / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D013917:Thrombin
keywords: Angiography; Arterial injury; Femoral catheterization; Percutaneous access