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Percutaneous thrombin injection of carotid artery pseudoaneurysm
Rebecca Holder1, Derek Hilton, Janis Martin
1Department of Radiology, Royal Liverpool University Hospital, England, UK.
Insights
Percutaneous thrombin injection successfully treated a carotid artery pseudoaneurysm in a patient with renal failure. This minimally invasive technique offers a promising new option for managing this vascular complication.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiology
Background:
- Carotid artery pseudoaneurysms can arise from iatrogenic injury.
- Management options for pseudoaneurysms include surgical repair and endovascular techniques.
- Treatment of pseudoaneurysms in patients with comorbidities presents unique challenges.
Observation:
- A 71-year-old male with end-stage renal failure developed a large carotid artery pseudoaneurysm after attempted jugular line insertion.
- Ultrasound-guided compression was ineffective for pseudoaneurysm treatment.
- A novel percutaneous approach using an occlusion balloon and direct thrombin injection was employed.
Findings:
- Instantaneous thrombosis of the pseudoaneurysm was achieved with percutaneous thrombin injection.
- The procedure was technically successful with no immediate complications.
- Follow-up ultrasound at 3 months confirmed complete resolution of the pseudoaneurysm and hematoma without neurological deficits.
Implications:
- Percutaneous thrombin injection represents a potentially safe and effective new treatment modality for carotid artery pseudoaneurysms.
- This technique may be particularly beneficial for patients who are poor surgical candidates.
- Further research is warranted to establish the long-term efficacy and safety of this interventional approach.
Purpose:
To report the successful treatment of a carotid artery pseudoaneurysm by percutaneous thrombin injection.
Case Report:
A 71-year-old man with end-stage renal failure presented with acute left ventricular failure. The right common carotid artery (CCA) was punctured during attempted jugular line insertion, and he developed a large pseudoaneurysm connected to the CCA by a long, narrow neck. Ultrasound-guided compression was unsuccessful, so another technique was attempted. An occlusion balloon was inflated in the CCA at the neck of the aneurysm to avoid distal embolization, and 250 units of human thrombin were injected into the sac percutaneously; thrombosis was instantaneous. There were no procedural complications, and repeat ultrasound at 3 months showed resolution of the hematoma and no residual pseudoaneurysm. There were no neurological complications.
Conclusions:
Percutaneous thrombin injection may be a new and successful method of treating carotid artery pseudoaneurysms.