title: Post-procedural pseudoaneurysms: Single-center experience.
abstract: Objectives Pseudoaneurysms are a well-recognized complication of percutaneous angiographic procedures. Ultrasound-guided thrombin injection is currently the preferred treatment modality. This study was undertaken to evaluate our experience with the management of post-procedure pseudoaneurysms. Methods A retrospective study was undertaken of all patients who developed a post-procedure pseudoaneurysm between March 2004 and January 2013. Data were obtained from our prospectively maintained non-invasive vascular laboratory data base. Results Overall, 167 patients (80 men) with post-procedure pseudoaneurysms were identified. The mean age was 66 years. Post-procedure pseudoaneurysms developed following diagnostic coronary angiography (38%), coronary angioplasty (37%), peripheral vascular interventions (14.7%), or other access procedures (7.6%). Mean post-procedure pseudoaneurysm diameter was 2.8 ± 1.8 cm. One hundred forty-two post-procedure pseudoaneurysms were injected with thrombin under ultrasound guidance. Primary success rate was 93.5%. There were 12 (8.5%) procedural failures of which seven (58%) responded to reinjection, three (25%) required operative management, one was treated with ultrasound-guided compression, and one (8.3%) was simply observed. On multivariate analysis, failures were associated with increased aneurysm diameter ( p = 0.006; odds ratio 2.23, 95% CI 1.25 to 3.96), end-stage renal disease ( p = 0.013; odds ratio 1.15, 95% CI 1.09 to 1.78) and superficial femoral artery aneurysm origin ( p = 0.031; odds ratio 0.20, 95% CI 0.04 to 0.86). There were two episodes of thrombus formation in the femoral artery; one resolved with anticoagulation alone, and the other required thrombectomy. Conclusions Percutaneous ultrasound-guided thrombin injection is an effective and safe method for managing post-procedure pseudoaneurysms. Failure rates are low and associated with large aneurysm size, superficial femoral artery origin and end-stage renal disease.
authors.affiliation: Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Farah
authors.initials: F
authors.lastname: Mohammad
authors.affiliation: Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Loay
authors.initials: L
authors.lastname: Kabbani
authors.affiliation: Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Lin
authors.affiliation: Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Efstathios
authors.initials: E
authors.lastname: Karamanos
authors.affiliation: Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Fatema
authors.initials: F
authors.lastname: Esmael
authors.affiliation: Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Shepard
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000009:adverse effects*; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007267:Injections; D016015:Logistic Models; D008297:Male; D008824:Michigan; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013917:Thrombin / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D013917:Thrombin
keywords: Pseudoaneurysms; complications; failure; thrombin injection