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

100%

Jargiełło T., Sobstyl J., Światłowski Ł., Kuczyńska M., Kuklik E., Sojka M., Drelich-Zbroja A., Pech M., Powerski M.

Journal of Ultrasonography

2018

vol. 18

issue 73

85-89

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.

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.

Non-enzymatic activation of prothrombin induced by interaction with fibrin β26-42 region

88%

Chernyshenko V., Chernyshenko T., Korolova D. y., Volynets G., Kolesnikova I., Platonova T., Lugovskoy E.

2015

vol. 62

issue 3

517-522

We have discovered that addition of monomeric desAB fibrin to prothrombin leads to appearance of the thrombin-like activity of prothrombin towards S2238 chromogenic substrate. DesA and desABβ(15-42)2 fibrin forms did not cause any activation of prothrombin. From this observation we could suggested that amino acid residues of the 15-42 fragment of BβN-domain presented in desAB fibrin, cleaved in desABβ(15-42)2 fibrin and protected in desA fibrin, play a crucial role in the non-enzymatic activation of prothrombin. To identify the Bβ amino acid residues involved in the fibrin-prothrombin binding we used monoclonal antibodies 1-5G and 2d2a with epitopes in Bβ26-42 and Bβ12-26 fibrin fragments respectively. The thrombin-like activity in the mixture of prothrombin and desAB fibrin was monitored in the presence of each of these monoclonal antibodies. It was found that anti-Bβ12-26 antibody does not exhibit any inhibitory effect on the thombin-like activity of the mixture. In contrast, adding of Bβ26-42 antibody into the mixture of desAB fibrin with prothrombin diminished the thrombin-like activity by 70%. Recombinant dimeric peptides Bβ(15-44)2 and Bβ(15-66)2 that mimic amino acid residues in fibrin were also tested for their ability to activate prothrombin. It was found that both peptides were able to induce non-enzymatic activation of prothrombin. The activation was more evident in the case of Bβ(15-44)2 peptide. From the data obtained we can conclude that desAB fibrin binds to prothrombin through the Bβ26-42 amino acid residues and the formation of such a complex caused a non-enzymatic activation of prothrombin.

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1 Acta Biochimica Polonica

1 Journal of Ultrasonography

1 2018

1 2015

1 Chernyshenko T.

1 Chernyshenko V.

1 Drelich-Zbroja A.

1 Jargiełło T.

1 Kolesnikova I.

1 Korolova D. y.

1 Kuczyńska M.

1 Kuklik E.

1 Lugovskoy E.

1 Pech M.

1 Platonova T.

1 Powerski M.

1 Sobstyl J.

1 Sojka M.

1 Volynets G.

1 Światłowski Ł.

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

Non-enzymatic activation of prothrombin induced by interaction with fibrin β26-42 region