Abstract
INTRODUCTION: Femoral pseudoaneurysms are a complication that occurs in connection with up to 8% of percutaneous procedures. Of the available treatments, ultrasound guided thrombin injection has a high success rate and is well-tolerated by patients. The combination of thrombin and fibrinogen known as fibrin sealant forms a stable clot and can be used to treat pseudoaneurysms, particularly those with complex anatomy and larger size. OBJECTIVE: To compare the results of treating femoral pseudoaneurysm in two ways: Group T was treated with thrombin alone and Group T+F was treated with fibrin sealant (thrombin+fibrinogen). METHODS: A retrospective analysis was conducted of femoral pseudoaneurysm cases treated between January 2005 and December 2012. RESULTS: Twenty-eight patients were treated, 21 with thrombin alone and seven with fibrin sealant. All patients in group T were treated successfully, but only four patients in group T+F were treated successfully (57.1% success rate in Group T+F, p<0.01). The three cases of failure in group T+F needed surgery and in one of these cases the complication was embolization to the femoral bifurcation. The pseudoaneurysms that were treated with fibrin sealant were larger (25 cm3 in Group T and 57.7 cm3 in Group T+F, p=0.02) and required larger volumes of thrombin (0.5 mL in Group T and 1.0 mL in Group T+F, p<0.01). There was one complication in Group T and two complications in Group T+F (p<0.01). CONCLUSIONS: Irrespective of the small number of cases reviewed, treatment with thrombin alone was superior to treating with fibrin sealant, since it caused few complications and was more effective at correcting pseudoaneurysms.
Highlights
Data were split into two groups: data from patients treated with thrombin alone in one group (Group T) and data from patients treated with fibrin sealant, which is basically thrombin and fibrinogen, in the other (Group T+F)
This change in conduct was made in response to observation of complications in cases treated with fibrin sealant
Twenty-eight patients were diagnosed with femoral pseudoaneurysms, 21 of whom were treated with thrombin injection alone and seven of whom were treated with thrombin+ fibrinogen injection
Summary
Femoral pseudoaneurysms are a complication that occurs in connection with up to 8% of percutaneous procedures. Objective: To compare the results of treating femoral pseudoaneurysm in two ways: Group T was treated with thrombin alone and Group T+F was treated with fibrin sealant (thrombin+fibrinogen). Conclusions: Irrespective of the small number of cases reviewed, treatment with thrombin alone was superior to treating with fibrin sealant, since it caused few complications and was more effective at correcting pseudoaneurysms. Femoral pseudoaneurysms are a possible complication of percutaneous vascular procedures. They have an incidence of 0.05% to 2% in diagnostic procedures and 8% in therapeutic procedures[1,2,3]. Several different studies have reported successful percutaneous treatment of pseudoaneurysms using puncture guided by ultrasound and thrombin injection[5,6,7,8]. The first choice treatment for pseudoaneurysms is percutaneous thrombin injection and surgery is reserved for cases in which this fails or for more complicated pseudoaneurysms[9,10,11]
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