Reducing duplex examinations in patients with iatrogenic pseudoaneurysms

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Devices

Background:

• Ultrasound-guided thrombin injection is the primary treatment for femoral access-related pseudoaneurysms.
• Current algorithms involve serial duplex examinations for small iatrogenic pseudoaneurysms (IPSAs) (<2.5 cm) and repeated studies for larger ones (>2.5 cm).

Purpose of the Study:

• To evaluate a revised treatment algorithm for IPSAs.
• This algorithm involves primary treatment of both small and large IPSAs.
• The goal was to reduce diagnostic and follow-up studies through a point-of-care strategy.

Main Methods:

• A retrospective review of 105 consecutive patients treated with ultrasound-guided thrombin injection from July 2001 to September 2004.
• Analysis of patient and IPSA characteristics, treatment methods, and the number of duplex examinations per patient.
• Comparison of primary treatment versus observation for small IPSAs using published cost data.

Main Results:

• Successful thrombosis was achieved in 98.1% (103/105) of treated pseudoaneurysms.
• No major complications occurred; failures requiring surgery were in the large aneurysm group.
• A point-of-care model reduced average duplex examinations from 3.3 to 1.5 per patient, saving laboratory time and ultrasounds.
• Primary treatment of small IPSAs resulted in an estimated cost saving of $12,000 annually.

Conclusions:

• Ultrasound-guided thrombin injection is a safe and effective treatment for most iatrogenic pseudoaneurysms.
• Primary treatment of small IPSAs is recommended over observation and serial duplex scans.
• A point-of-care treatment algorithm can lead to significant cost savings by minimizing duplex examinations.