Treatment of iatrogenic pseudo-aneurysms with ultrasonography-guided percutaneous thrombin injection and compression : Treatment of iatrogenic pseudo-aneurysms

Deniz  Ozturk Kocakgol; Sukru  Oguz; Süleyman Bekirçavuşoğlu; Hasan Dinç

doi:10.28982/josam.7498

Authors

Deniz Ozturk Kocakgol Department of Radiology, Mareşal Çakmak State Hospital, Erzurum, Turkey https://orcid.org/0000-0003-3780-2173
Sukru Oguz Department of Radiology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey https://orcid.org/0000-0002-1354-8898
Süleyman Bekirçavuşoğlu Department of Radiology, Bursa City Hospital, Bursa, Turkey https://orcid.org/0000-0002-7831-3459
Hasan Dinç MD Department of Radiology, School of Medicine, Karadeniz Tecnical University, Trabzon, Turkey https://orcid.org/0000-0002-0738-1809

DOI:

https://doi.org/10.28982/josam.7498

Keywords:

iatrogenic pseudoaneurysms, US-guided compression, US-guided percutaneous thrombin injection

Abstract

Background/Aim: Recently, endovascular interventional procedures have become prevalent. Thus, complications due to arterial catheterization are frequent. The most common access site complications are pseudo-aneurysms (PSAs). The present study aimed to treat iatrogenic pseudo-aneurysm (PSA) with ultrasonography (US)-guided compression and percutaneous thrombin injection and to report these methods’ effectiveness and short-term outcomes.

Methods: The study was designed as a retrospective cohort study. Two treatment techniques were performed. Forty-eight of 54 patients were included in the study. Forty patients were treated with US-guided percutaneous thrombin injection, and eight were treated with US-guided compression. Six of the 54 patients were excluded from the study. Two of these patients needed further surgical treatment. The other four patients needed no further intervention due to spontaneous thrombosis of PSA. The patient demographics, history of AC/AA drug use, indication for performing arterial catheterization, localization and size of PSAs, treatment method applied, the effectiveness of treatment, early outcomes, and the treatment complications were evaluated.

Results: In eight patients treated with US-guided compression, recurrent filling was not observed at the 24-h and first-month post-treatment follow-ups, and 100% success was achieved. Among the 40 patients treated with percutaneous thrombin injection for whom a second session was applied, recurrent filling was observed in six PSAs at the 24-h post-treatment follow-up. While the treatment success rate was 85% in the first session, it increased to 97.5% after the second session. A first-month follow-up could be made in 84.6% of the treated patients, and recurrence was observed in no patients.

Conclusion: US-guided thrombin injection for PSAs has a high success rate. It is practical, relatively rapid to perform, has low complication rates, and may be selected as the first treatment choice for PSA.

Downloads

Download data is not yet available.

Author Biographies

Süleyman Bekirçavuşoğlu, Department of Radiology, Bursa City Hospital, Bursa, Turkey

Süleyman BEKİRÇAVUŞOĞLU, MD Department of Radiology, Bursa City Hospital, Bursa, Turkey

Hasan Dinç, MD Department of Radiology, School of Medicine, Karadeniz Tecnical University, Trabzon, Turkey

Hasan DİNÇ, MD Department of Radiology, School of Medicine, Karadeniz Tecnical University, Trabzon, Turkey

References

Mauro MA, Murphy KP, Thomson KR, Venbrux AC, Morgan RA. Image-guided interventions e-book: Expert radiology series (Expert Consult-Online and Print): Elsevier Health Sciences; 2013.

Saad NE, Saad WE, Davies MG, Waldman DL, Fultz PJ, Rubens DJ. Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics. 2005;25(suppl_1):S173-89. doi: 10.1148/rg.25si055503

Ahmad F, Turner S, Torrie P, Gibson M. Iatrogenic femoral artery pseudo-aneurysms—A review of current methods of diagnosis and treatment. Clinical Radiology. 2008;63(12):1310-6. doi: 10.1016/j.crad.2008.07.001

Hung B, Gallet B, Hodges TC. Ipsilateral femoral vein compression: A contraindication to thrombin injection of femoral pseudo-aneurysms. Journal of Vascular Surgery. 2002;35(6):1280-3. doi: 10.1067/mva.2002.121748

La Perna L, Olin JW, Goines D, Childs MB, Ouriel K. Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudo-aneurysms. Circulation. 2000;102(19):2391-5. doi: 10.1161/01.CIR.102.19.2391

Fellmeth BD, Roberts AC, Bookstein JJ, Freischlag JA, Forsythe JR, Buckner NK, et al. Postangiographic femoral artery injuries: Nonsurgical repair with US- guided compression. Radiology. 1991;178:671–75. doi: 10.1148/radiology.178.3.1994400

Kang SS, Labropoulos N, Mansour MA, Baker WH. Percutaneous ultrasound guided thrombin injection: A new method for treating postcatheterization femoral pseudo-aneurysms. J Vasc Surg. 1998;27:1032–38. doi: 10.1016/S0741-5214(98)70006-0

Morgan R, Belli A-M. Current treatment methods for postcatheterization pseudo-aneurysms. Journal of Vascular and Interventional Radiology. 2003;14(6):697-710. doi: 10.1097/01.RVI.0000071089.76348.6A

Cope C, Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection. American Journal of Roentgenology. 1986;147(2):383-7. doi: 10.2214/ajr.147.2.383

Liau C-S, Ho F-M, Chen M-F, Lee Y-T. Treatment of iatrogenic femoral artery pseudo-aneurysm with percutaneous thrombin injection. Journal of Vascular Surgery. 1997;26(1):18-23. doi: 10.1016/S0741-5214(97)70141-1

Webber GW, Jang J, Gustavson S, Olin JW. Contemporary management of postcatheterization pseudo-aneurysms. Circulation. 2007;115(20):2666-74. doi: 10.1161/CIRCULATIONAHA.106.681973

Steinkamp HJ, Werk M, Felix R. Treatment of postinterventional pseudo-aneurysms by ultrasound-guided compression. Investigative Radiology. 2000;35(3):186-92.

Dean SM, Olin JW, Piedmonte M, Grubb M, Young JR. Ultrasound-guided compression closure of postcatheterization pseudo-aneurysms during concurrent anticoagulation: A review of seventy-seven patients. Journal of Vascular Surgery. 1996;23(1):28-35. doi: 10.1016/S0741-5214(05)80032-1

Eisenberg L, Paulson E, Kliewer M, Hudson M, DeLong D, Carroll B. Sonographically guided compression repair of pseudo-aneurysms: Further experience from a single institution. AJR American Journal of Roentgenology. 1999;173(6):1567-73. doi: 10.2214/ajr.173.6.10584803

Cox GS, Young JR, Gray BR, Grubb MW, Hertzer NR. Ultrasound-guided compression repair of postcatheterization pseudo-aneurysms: Results of treatment in one hundred cases. Journal of Vascular Surgery. 1994;19(4):683-6. doi: 10.1016/S0741-5214(94)70042-7

Coley BD, Roberts AC, Fellmeth BD, Valji K, Bookstein JJ, Hye RJ. Postangiographic femoral artery pseudo-aneurysms: Further experience with US-guided compression repair. Radiology. 1995;194(2):307-11. doi: 10.1148/radiology.194.2.7824703

Krueger K, Zaehringer M, Strohe D, Stuetzer H, Boecker J, Lackner K. Postcatheterization pseudo-aneurysm: Results of US-guided percutaneous thrombin injection in 240 patients. Radiology. 2005;236(3):1104-10. doi: 10.1148/radiol.2363040736

Sheiman RG, Mastromatteo M. Iatrogenic femoral pseudo-aneurysms that are unresponsive to percutaneous thrombin injection: Potential causes. American Journal of Roentgenology. 2003;181(5):1301-4. doi: 10.2214/ajr.181.5.1811301

Paulson EK, Nelson RC, Mayes CE, Sheafor DH, Sketch Jr MH, Kliewer MA. Sonographically guided thrombin injection of latrogenic femoral pseudo-aneurysms: Further experience of a single institution. American Journal of Roentgenology. 2001;177(2):309-16. doi: 10.2214/ajr.177.2.1770309

Mishra A, Rao A, Pimpalwar Y. Ultrasound Guided Percutaneous Injection of Thrombin: Effective Technique for Treatment of Iatrogenic Femoral Pseudoaneurysms. J Clin Diagn Res. 2017 Apr;11(4):TC04-TC06. doi: 10.7860/JCDR/2017/25582.9512. Epub 2017 Apr 1. PMID: 28571227; PMCID: PMC5449873.

Khoury M, Rebecca A, Greene K, Rama K, Colaiuta E, Flynn L, et al. Duplex scanning–guided thrombin injection for the treatment of iatrogenic pseudo-aneurysms. Journal of Vascular Surgery. 2002;35(3):517-21. doi: 10.1067/mva.2002.120029

Paulson EK, Kliewer MA, Hertzberg BS, Tcheng JE, McCann RL, Bowie JD, et al. Ultrasonographically guided manual compression of femoral artery injuries. Journal of Ultrasound in Medicine. 1995;14(9):653-9. doi: 10.7863/jum.1995.14.9.653

Lennox A, Delis K, Szendro G, Griffin M, Nicolaides A, Cheshire N. Duplex‐guided thrombin injection for iatrogenic femoral artery pseudo-aneurysm is effective even in anticoagulated patients. British Journal of Surgery. 2000;87(6):796-801. doi: 10.1046/j.1365-2168.2000.01436.x

Friedman SG, Pellerito JS, Scher L, Faust G, Burke B, Safa T. Ultrasound-guided thrombin injection is the treatment of choice for femoral pseudo-aneurysms. Archives of Surgery. 2002;137(4):462-4. doi: 10.1001/archsurg.137.4.462

Weinmann E, Chayen D, Kobzantzev Z, Zaretsky M, Bass A. Treatment of postcatheterisation false aneurysms: ultrasound-guided compression vs ultrasound-guided thrombin injection. European journal of vascular and endovascular surgery. 2002;23(1):68-72. doi: 10.1053/ejvs.2001.1530

Pope M, Johnston K. Anaphylaxis after thrombin injection of a femoral pseudo-aneurysm: recommendations for prevention. Journal of Vascular Surgery. 2000;32(1):190-1. doi: 10.1067/mva.2000.106498

Sheldon PJ, Oglevie SB, Kaplan LA. Prolonged generalized urticarial reaction after percutaneous thrombin injection for treatment of a femoral artery pseudo-aneurysm. Journal of vascular and interventional radiology: JVIR. 2000;11(6):759-61. doi: 10.1016/s1051-0443(07)61636-4

Pezzullo JA, Dupuy DE, Cronan JJ. Percutaneous injection of thrombin for the treatment of pseudo-aneurysms after catheterization: an alternative to sonographically guided compression. American Journal of Roentgenology. 2000;175(4):1035-40. doi: 10.2214/ajr.175.4.1751035.

Treatment of iatrogenic pseudo-aneurysms with ultrasonography-guided percutaneous thrombin injection and compression