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Femoral pseudoaneurysm thrombinjection
S S Gale1, R P Scissons, L Jones
1Jobst Vascular Center, 2109 Hughes Drive, Suite 400, Toledo, Ohio 43606, USA. sgale@jvc.org
American Journal of Surgery
|July 5, 2001
Summary
Thrombin injection effectively treats pseudoaneurysms after catheterization. Careful technique, including slow injection and ultrasound guidance, ensures successful thrombosis and minimizes risks.
Area of Science:
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Pseudoaneurysms (PSA) are a complication of cardiovascular catheterization.
- Thrombin injection offers an effective and economical alternative to compression or surgery for PSA treatment.
- Concerns about systemic arterial thrombosis have limited widespread adoption of thrombin injection.
Purpose of the Study:
- To report on cautionary steps and lessons learned from the first 20 cases of thrombin injection for pseudoaneurysm treatment.
- To evaluate the efficacy and safety of ultrasound-guided thrombin injection for pseudoaneurysms.
Main Methods:
- Twenty patients (12 women, 8 men) with femoral pseudoaneurysms underwent ultrasound-guided thrombin injection.
- Thrombin (100-2,300 units) was slowly injected into the pseudoaneurysm sac, avoiding the neck.
- Key techniques included slow injection, thrombus ball positioning, and probe compression using ultrasound.
Main Results:
- All pseudoaneurysms successfully thrombosed on the first treatment.
- Pseudoaneurysm sizes ranged from 17-39 mm with neck openings of 1.5-3.9 mm.
- One patient experienced fever; another required compression for a separate pseudoaneurysm.
Conclusions:
- Successful thrombin injection is achievable for common femoral artery pseudoaneurysms with small neck openings.
- Avoiding arteriovenous fistulas and employing specific techniques like slow injection and probe compression are crucial.
- Standard thrombin concentration and advanced ultrasonography contribute to successful outcomes.