A prospective study on ultrasound-guided percutaneous thrombin injection for treatment of iatrogenic post-catheterisation femoral pseudoaneurysms

Abstract

Background The purpose of this study was to evaluate prospectively the safety and efficacy of bovine thrombin injection for the treatment of iatrogenic post-catheterisation pseudoaneurysms. Methods and results A total of 274 patients (90 women, 184 men, 69.8 ± 7 years) with iatrogenic femoral pseudoaneurysms were treated by ultrasound-guided thrombin injection (UGTI). The deepest pseudoaneurysm chamber was entered with a 0.90 × 40 mm or 90 mm needle and bovine thrombin (solution of 1000 U/ml) was injected. Pseudoaneurysms were associated with diagnostic cardiac catheterisation, percutaneous coronary intervention or invasive electrophysiologic investigation. The majority of the patients were under antiplatelet therapy with aspirin or clopidogrel or both, and additional low dose heparin therapy. A total of 52 patients were treated with either phenprocoumon or enoxaparine body weight adjusted. UGTI was primary successful in 267 of 274 patients (97%). In 3 of 7 patients with a remaining pseudoaneurysm a second injection was required. Three patients were treated by ultrasound-guided compression. One patient was treated by surgical repair of the pseudoaneurysm 1 day after UGTI because a further pseudoaneurysm developed under phenprocoumon therapy. UGTI-related complications such as significant arterial thrombotic events or allergic reactions did not occur. 75 patients (27%) were evaluated by an additional sonography after 3 months to assess the long-term effect. Conclusion UGTI was well tolerated, safe and primarily effective in 97% of patients with iatrogenic femoral pseudoaneurysms. Anticoagulant use did not hinder successful thrombosis. UGTI should be considered as first-line therapy for the treatment of post-catheterisation pseudoaneurysms.