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Ultrasound-guided thrombin injection for cardiac catheterization pseudoaneurysms: efficacy, safety, and predictors
Edgar Bortolini1, Tulio Fabiano de Oliveira Leite1, Bruno Renan Ribeiro Gomes Linard1
1Interventional Radiologist, Radiology Department, Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brazil.
Background:
Percutaneous ultrasound-guided thrombin injection has become the gold standard treatment for pseudoaneurysms caused by cardiac catheterization. However, failure can occur in up to 25% of the procedures and little is known about its causes.
Purpose:
To study the efficacy and safety of the technique and to determine possible risk factors responsible for the unsuccess.
Material And Methods:
A cohort study was carried out based on data from medical records collected between December 2012 and June 2020 of 110 patients with the diagnosis of pseudoaneurysm, femoral or radial, secondary to cardiac catheterization. Clinical data, pseudoaneurysm morphological parameters, and technical factors related to catheterization were reviewed.
Results:
Primary and global technical success rates were 85.5% and 100%, respectively. Age, neck, and anteroposterior diameter variables were predictors of primary failure on multivariate analysis. The odds ratio (OR) for age was 0.960 (95% confidence interval [CI]=0.927-0.995; P = 0.025), for anteroposterior diameter, OR was 2.023 (95% CI=1.144-3.578; P = 0.015), and for neck diameter, it was 4.625 (95% CI=1.023-20.904; P = 0.047). The receiver operating characteristic (ROC) curve was performed for the multivariate analysis model and the three predictors of failure. The area under the curve for the multivariate analysis model was 0.695, for age it was 0.675, for anteroposterior diameter it was 0.679, and for neck diameter it was 0.676. No complications were observed.
Conclusions:
Percutaneous ultrasound-guided thrombin injection is safe and effective for the treatment of pseudoaneurysms after cardiac catheterization. Largest anteroposterior diameter, largest neck diameter, and a younger age were independent predictors of primary failure with the technique.
