Ultrasound-guided thrombin injection in the management of pseudoaneurysm after percutaneous arterial access

• Authors: Tomasz Jargiełło , Jan Sobstyl , Łukasz Światłowski , Maryla Kuczyńska , Ewa Kuklik , Michał Sojka , Anna Drelich-Zbroja , Maciej Pech , Maciej Powerski

Title variants

PL

Wstrzyknięcie trombiny pod kontrolą ultrasonografii w leczeniu tętniaków rzekomych po zabiegach z przezskórnego dostępu tętniczego

• Languages of publication: EN PL

Abstracts

EN

Aim: The purpose of this paper was to evaluate the efficacy of ultrasound-guided percutaneous thrombin injection as a treatment method for arterial access site pseudoaneurysm. Materials and methods: A total of 148 patients with iatrogenic arterial access site pseudoaneurysms were treated in the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin. Of those, 142 pseudoaneurysms were located in the common femoral artery, 3 in the brachial artery and the remaining 3 in the radial artery. The study included 77 woman and 71 men (mean age 64.5 ± 14 years). Patients were qualified for percutaneous thrombin injection after Doppler examination during which pseudoaneurysm size and morphology were assessed as well as the presence of arteriovenous fistula was excluded. Results: In the reported study, 94.8% (128/135) of patients were successfully treated during the initial thrombin injection. Additional 400 IU dose of thrombin after 24 hours was effective in 5 out of 7 patients with recanalization during the follow-up. A total of 98.5% (133/135) of patients were successfully treated with a percutaneous ultrasound-guided thrombin injection. Conclusions: The 10-year experience presented in this study as well as literature reports prove that percutaneous ultrasound-guided thrombin injection is an effective and safe treatment method for iatrogenic arterial access site pseudoaneurysm.

PL

Cel pracy: Celem pracy była ocena skuteczności przezskórnego wstrzyknięcia trombiny pod kontrolą ultrasonografii jako sposobu leczenia tętniaka rzekomego w miejscu dostępu tętniczego. Materiał i metody: W Zakładzie Radiologii Zabiegowej i Neuroradiologii Uniwersytetu Medycznego w Lublinie leczeniu poddano 148 pacjentów z jatrogennymi tętniakami rzekomymi w miejscu dostępu tętniczego, przy czym 142 pseudotętniaki były umiejscowione w tętnicy udowej wspólnej, 3 w tętnicy ramiennej oraz pozostałe 3 w tętnicy promieniowej. W badaniu udział wzięło 77 kobiet i 71 mężczyzn (średni wiek 64,5 ± 14 lat). Pacjentów kwalifikowano do przezskórnego wstrzyknięcia trombiny po wykonaniu badania ultrasonograficznego z funkcją dopplera w celu oceny wielkości i morfologii tętniaka rzekomego oraz wykluczenia obecności przetoki tętniczo-żylnej. Wyniki: W przedstawionym badaniu skuteczność leczenia po pierwszym wstrzyknięciu trombiny uzyskano u 94,8% (128/135) pacjentów. Dodatkowa dawka trombiny wynosząca 400 j.m. podana po upływie 24 godzin okazała się skuteczna u 5 na 7 pacjentów, u których podczas badania kontrolnego stwierdzono rekanalizację. Skuteczność leczenia metodą przezskórnego wstrzyknięcia trombiny pod kontrolą ultrasonografii uzyskano u 98,5% (133/135) badanych. Wnioski: Z przedstawionego w niniejszej pracy 10-letniego doświadczenia oraz doniesień z piśmiennictwa wynika, że przezskórna podaż trombiny pod kontrolą ultrasonografii stanowi skuteczną i bezpieczną metodę leczenia jatrogennych tętniaków rzekomych w miejscu dostępu tętniczego.

Keywords

EN

interventionalultrasonography; pseudoaneurysm; thrombin

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Journal of Ultrasonography
• Year: 2018
• Volume: 18
• Issue: 73
• Pages: 85–89

Contributors

author

Tomasz Jargiełło

• Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland

author

Jan Sobstyl

• Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland

author

Łukasz Światłowski

• Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland

author

Maryla Kuczyńska

• Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland

author

Ewa Kuklik

• Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland

author

Michał Sojka

• Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland

author

Anna Drelich-Zbroja

• Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland

author

Maciej Pech

• Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany

author

Maciej Powerski

• Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany

References

• 1. Ahmad F, Turner SA, Torrie P, Gibson M: Iatrogenic femoral artery pseudoaneurysms: A review of current methods of diagnosis and treatment. Clin Radiol 2008; 63: 1310–1316.
• 2. Périard D, Rey Meyer MA, Hayoz D, Cook S: Sealing pseudo-aneurysms of the femoral artery with saline injection: A new technique. EuroIntervention 2012; 7: 1206–1209.
• 3. Nakai M, Sato M, Sanda H, Ikoma A, Kawai N, Minamiguchi H et al.: Percutaneous fluoroscopically guided n-butyl cyanoacrylate (NBCA) injection for iatrogenic femoral arterial pseudoaneurysm under temporary balloon occlusion of arterial blood flow. Jpn J Radiol 2012; 30: 365–369.
• 4. Ibrahim K, Christoph M, Wunderlich C, Jellinghaus S, Loehn T, Youssef A et al.: A novel interventional method for treating femoral pseudoaneurysms: Results from a monocentric experience. EuroIntervention 2017; 13: 366–370.
• 5. Del Corso A, Vergaro G: Percutaneous treatment of iatrogenic pseudoaneurysms by cyanoacrylate-based wall-gluing. Cardiovasc Intervent Radiol 2013; 36: 669–675.
• 6. Stone PA, Martinez M, Thompson SN, Masinter D, Campbell JE, Campbell li JR et al.: Ten-year experience of vascular surgeon management of iatrogenic pseudoaneurysms: Do anticoagulant and/or antiplatelet medications matter? Ann Vasc Surg 2016; 30: 45–51.
• 7. Wongwanit C, Ruangsetakit C, Sermsathanasawadi N, Chinsakchai K, Mutirangura P: Treatment of iatrogenic pseudoaneurysm of brachial artery with percutaneous ultrasonographically guided thrombin injection (PUGTI): A case report and a literature review. J Med Assoc Thai 2007; 90: 1673–1679.
• 8. Liau CS, Ho FM, Chen MF, Lee YT: Treatment of iatrogenic femoral artery pseudoaneurysm with percutaneous thrombin injection. J Vasc Surg 1997; 26: 18–23.
• 9. Lönn L, Olmarker A, Geterud K, Risberg B: Prospective randomized study comparing ultrasound-guided thrombin injection to compression in the treatment of femoral pseudoaneurysms. J Endovasc Ther 2004; 11: 570–576.
• 10. Shah KJ, Halaharvi DR, Franz RW, Jenkins Ii J: Treatment of iatrogenic pseudoaneurysms using ultrasound-guided thrombin injection over a 5-year period. Int J Angiol 2011; 20: 235–242.
• 11. Sackett WR, Taylor SM, Coffey CB, Viers KD, Langan EM 3rd, Cull DL et al.: Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms: A prospective analysis. Am Surg 2000; 66: 937–942.
• 12. Calton WC Jr, Franklin DP, Elmore JR, Han DC: Ultrasound-guided thrombin injection is a safe and durable treatment for femoral pseudoaneurysms. Vasc Surg 2001; 35: 379–383.
• 13. Olsen DM, Rodriguez JA, Vranic M, Ramaiah V, Ravi R, Diethrich EB: A prospective study of ultrasound scan-guided thrombin injection of femoral pseudoaneurysm: A trend toward minimal medication. J Vasc Surg 2002; 36: 779–782.
• 14. Schneider C, Malisius R, Küchler R, Lampe F, Krause K, Bahlmann E et al.: A prospective study on ultrasound-guided percutaneous thrombin injection for treatment of iatrogenic post-catheterisation femoral pseudoaneurysms. Int J Cardiol 2009; 131; 131: 356–361.
• 15. Garvin RP, Ryer EJ, Yoon HR, Kendrick JB, Neidrick TJ, Elmore JR et al.: Ultrasound-guided percutaneous thrombin injection of iatrogenic upper extremity pseudoaneurysms. J Vasc Surg 2014; 59: 1664–1669.
• 16. Forbes TL, Millward SF: Femoral artery thrombosis after percutaneous thrombin injection of an external iliac artery pseudoaneurysm. J Vasc Surg 2001; 33: 1093–1096.
• 17. Gabrielli R, Rosati MS, Vitale S, Millarelli M, Chiappa R, Siani A et al.: Fatal complication after thrombin injection for post-catheterization femoral pseudoaneurysm. Thorac Cardiovasc Surg 2011; 59: 372–375.
• 18. Jalaeian H, Misselt A: Anaphylactic reaction to bovine thrombin in ultrasound-guided treatment of femoral pseudoaneurysm. J Vasc Interv Radiol 2015; 26: 915–916.
• 19. Pope M, Johnston KW: Anaphylaxis after thrombin injection of a femoral pseudoaneurysm: Recommendations for prevention. J Vasc Surg 2000; 32: 190–191.
• 20. Ferguson JD, Banning A: Ultrasound guided percutaneous thrombin injection for the treatment of iatrogenic pseudoaneurysms. Heart 2000; 83: 582.
• 21. Randleman CD Jr, Singla NK, Renkens KL, Souza S, Pribble JP, Alexander WA: Persistence of antibodies to the topical hemostat bovine thrombin. J Am Coll Surg 2010; 211: 798–803.

• Document Type: article