Regarding "Percutaneous coil embolization of postcatheterization arterial femoral pseudoaneurysms".

Abstract

We read with interest the article by Dr Kobeiter and colleagues.1Kobeiter H Lapeyre M Becquemin JP Mathieu D Melliere D Desgranges P. Percutaneous coil embolization of postcatheterization arterial femoral pseudoaneurysms.J Vasc Surg. 2002; 36: 127-131Abstract Full Text PDF PubMed Scopus (34) Google Scholar The use of percutaneous coil embolization to treat iatrogenic femoral pseudoaneurysm indeed is an interesting therapeutic option. Nonetheless, the use of duplex scanning-guided thrombin injection should not be regarded as obsolete. The efficacy and minimally invasive nature of thrombin injection, even in patients who have received anticoagulation therapy, has been well described.2Kang SS Labropoulos N Mansour MA Michelini M Filliung D Baubly MP et al.Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms.J Vasc Surg. 2000; 31: 289-298Abstract Full Text Full Text PDF PubMed Scopus (258) Google Scholar, 3Lennox AF Delis KT Szendro G Griffin MB Nicolaides AN Cheshire NJ. Duplex-guided thrombin injection for iatrogenic femoral artery pseudoaneurysm is effective even in anticoagulated patients.Br J Surg. 2000; 87: 796-801Crossref PubMed Scopus (70) Google Scholar Its advantages over duplex scanning-guided compression therapy are similarly well documented.4Khoury M Rebecca A Greene K Rama K Colaiuta E Flynn L et al.Duplex scanning-guided thrombin injection for the treatment of iatrogenic pseudoaneurysms.J Vasc Surg. 2002; 35: 517-521Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar Though we acknowledge the limitations of bovine thrombin due to hypersensitivity reaction and the theoretical risk for prion protein transmission, Dr Kobeiter and colleagues have not considered the use of human and autologous thrombin. In our unit a conservative policy is generally used to treat aneurysms smaller than 2 cm in diameter, the majority of which resolve. For aneurysms larger than 2 cm in diameter, we and other units in the United Kingdom have found treatment with human thrombin highly efficacious.5Sultan S Nicholls S Madhavan P Colgan MP Moore D Shanik G. Ultrasound guided human thrombin injection: a new modality in the management of femoral artery pseudo-aneurysms.Eur J Vasc Endovasc Surg. 2001; 22: 542-545Abstract Full Text PDF PubMed Scopus (21) Google Scholar, 6Elford J Burrell C Freeman S Roobottom C. Human thrombin injection for the percutaneous treatment of iatrogenic pseudoaneurysms.Cardiovasc Intervent Radiol. 2002; 25: 115-118Crossref PubMed Scopus (44) Google Scholar It is well tolerated, and we are unaware of any reports of hypersensitivity reaction in the literature. Furthermore, it averts the need for contrast angiography described during coil embolization. However, theoretical risk for infection transmission does exist. Recently Quarmby et al reported success with autologous thrombin. This technique negates the risk for infection transmission and hypersensitivity while remaining cost-effective.7Quarmby JW Engelke C Chitolie A Morgan RA Belli AM. Autologous thrombin for treatment of pseudoaneurysms.Lancet. 2002; 16: 946-947Abstract Full Text Full Text PDF Scopus (32) Google Scholar We recommend that duplex scanning-guided human or autologous thrombin injection remain the mainstay of treatment of iatrogenic pseudoaneurysm.