Percutaneous ultrasound-guided thrombin injection for the treatment of pseudoaneurysms11No competing interests declared.

Abstract

Because of the ever-increasing use of percutaneous intervention for coronary and peripheral disease and the large numbers of diagnostic procedures being performed each year, postcatheterization pseudoaneurysms (PSAs) are becoming increasingly prevalent. With the introduction of the landmark technique of ultrasound-guided compression, Fellmeth and colleagues revolutionized the treatment of PSAs. Unfortunately, ultrasound-guided compression is associated with a relatively low overall success rate of 42% to 100%, which is even lower in patients who are on anticoagulation therapy. In addition, procedural pain necessitates early termination and procedure failure in up to 10% of patients. Finally, long procedure times, ranging from 10 to 300 minutes, result in both patient and physician dissatisfaction with the procedure. Topical bovine-derived thrombin has been in widespread surgical use for local hemostasis for years. Thrombin serves to propagate the final pathway of the coagulation cascade by initiating fibrinogen to form thrombin. Although the original description of percutaneous thrombin injection for the treatment of PSAs was first made by Cope and Zeit in 1986 and followed by Walker and colleagues in 1987, it was not until the addition of ultrasound guidance by Liau and colleagues that the technique gained widespread acceptance. The purpose of this article is to review the technique and the basis for the use of thrombin in the treatment of PSAs. Results of all published series to date, complications, and treatment strategies will be discussed.