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[Treatment of pseudoaneurysms with injection of thrombin]
M Vrsanský1, J Mad'aric, I Vulev
1Kardiologická klinika SUSCH Pod Krásnou hôrkou 1 833 48 Bratislava Slovenská republika. vrsansky@pobox.sk
Objectives:
To introduce and assess the efficacy and risks associated with a new treatment method of post-catheterization pseudoaneurysms.
Methods:
Thrombin injection was indicated in patients with failure of compression therapy during 24 hours. Patients with a cavity volume < 1 cm3, with a pseudoaneurysm causing compression or haemorrhagic shock were excluded. A needle is introduced under local anaesthesia with ultrasound guidance, its tip is placed thoroughly in the centre of the cavity. Subsequently, under colour-flow mapping, thrombin solution with concentration of 1000 IU/ml is cautiously injected, which results in instantaneous thrombosis of the pseudoaneurysm cavity.
Results:
Thrombin injection was used in 17 patients during a period of 12 months. 12 of them were women, 6 patients with valvular disease, 2 after intervention and 5 anticoagulated. The method was successful in 16 patients. In 5 of them, a small residual cavity persisted, which was not suitable for re-injection, and was closed completely after a few minutes of compression by a ultrasound transducer. There were no thrombotic complications.
Conclusion:
Although compression remains the method of choice, thrombin injection is a highly effective, quick and, with necessary precautions, safe alternative to surgical treatment of pseudoaneurysms, mainly in anticoagulated patients.