Tratamiento de pseudoaneurismas arteriales yatrógenos con inyección de trombina humana

Abstract

Summary Introduction The incidence of iatrogenic pseudoaneurysms has risen due to the increased number of intervention approaches and the associated anticoagulation. The search for an effective treatment as opposed to surgery has been a challenge over the last few years.Aims. To analyse the effectiveness and safety of treatment with human thrombin (HT) in a series of 10 iatrogenic pseudoaneurysms. Patients and methods Eight patients (five females and three males), with an average age of 67years (46-85), had a total number of 10pseudoaneurysms in the common femoral artery, secondary to cardiac catherization (five), diagnostic arteriography (one), cerebral aneurysm embolization (one) and intraarterial fibrinolysis (one). Selection for treatment was based on the following: a diameter above 15 mm (15-35) and localization had to be anterior with respect to the artery. Saline solution of HT (100 U/cm3, from Tissucol®) and a 22G needle were used. 100-400 U were injected into the cavity by echographically-guided percutaneous injection. Two patients received anticoagulants during the procedure. Ankle-arm indices and pulses were explored before and after the injection. Controls were conducted at 24 hours, 2 and 6 months. Results The total thrombosis of the cavity came about after only a few seconds, without any changes in ankle-arm index or pulses. There was only one relapse in apseudoaneurysm, at 24 hours. Conclusions Treatment using percutaneous HT injection is effective (90% primary thrombosis), safe (without pain or complications in our series) and of short duration for the first-line treatment of iatrogenic femoral pseudoaneurysms.