Treatment of Postcatheterization Pseudoaneurysms: Possibilities of
Percutaneous Thrombin Administration as a New Method
Raupach J.1, Chovanec V.1, Lojík M.1, Krajina A.1, Fridrich J.2, Hudík M.2, Tuna M.3
Radiologická klinika FN, Hradec Králové1 přednosta doc. MUDr. P. Eliáš, CSc.I. interní klinika FN, Hradec Králové2 přednosta doc. MUDr. M. Pleskot, CSc.Kardiochirurgická klinika FN, Hradec Králové3přednosta prof. MUDr. J. Dominik, CSc. |
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Summary:
Introduction: Femoral artery pseudoaneurysm (PSA) occurs as a complication of arterial catheterizations,
with a reported incidence of 0.1–7.5 %, and are more common in the era of larger introducer
sheaths, anticoagulation, and more complex interventions. Recently reported new treatment for
femoral pseudoaneurysms after failure US guided compression involves percutaneous injection of
thrombin into the PSA sac under sonographic guidance.
Objective: The aim of study was to evaluate safety and efficacy of ultrasound-guided percutaneous
thrombin injection in the treatment of catheter-induced false aneurysms.
Material and methods: Between August 2001 and December 2002 authors treated 18 patients (7
female, 11 male, mean age 71.7 years) by thrombin injection into the PSA sac. The PSA diameter
ranged from 8 to 45 mm, the mean diameter was 27 mm. An average dose of 420 U of thrombin was
used and the total time of procedure was 13.5 min.
Results: The thrombin injection was immediately successful in 17/18 patients, so primary success
was 94.4 %. In one large aneurysm (45 mm) only partial success was achieved, therefore repeated
treatment was necessary. One late recanalization was revealed 3 weeks after the treatment and
a successful second thrombin injection was administered. No thrombotic complications or adverse
events were observed.
Conclusion: US guided thrombin injection offers an effective, less expensive, quick and well-tolerated
therapy of iatrogenic femoral PSA without the need for sedation or analgesia. Authors use this
method after unsuccessful US-guided compression.
Key words:
pseudoaneurysm – angiography – complication – thrombin – ultrasound
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