Treatment of iatrogenic pseudo-aneurysms with ultrasonography-guided percutaneous thrombin injection and compression

Abstract

Background/Aim: Recently, endovascular interventional procedures have become prevalent. Thus, complications due to arterial catheterization are frequent. The most common access site complications are pseudo-aneurysms (PSAs). The present study aimed to treat iatrogenic pseudo-aneurysm (PSA) with ultrasonography (US)-guided compression and percutaneous thrombin injection and to report these methods’ effectiveness and short-term outcomes. Methods: The study was designed as a retrospective cohort study. Two treatment techniques were performed. Forty-eight of 54 patients were included in the study. Forty patients were treated with US-guided percutaneous thrombin injection, and eight were treated with US-guided compression. Six of the 54 patients were excluded from the study. Two of these patients needed further surgical treatment. The other four patients needed no further intervention due to spontaneous thrombosis of PSA. The patient demographics, history of AC/AA drug use, indication for performing arterial catheterization, localization and size of PSAs, treatment method applied, the effectiveness of treatment, early outcomes, and the treatment complications were evaluated. Results: In eight patients treated with US-guided compression, recurrent filling was not observed at the 24-h and first-month post-treatment follow-ups, and 100% success was achieved. Among the 40 patients treated with percutaneous thrombin injection for whom a second session was applied, recurrent filling was observed in six PSAs at the 24-h post-treatment follow-up. While the treatment success rate was 85% in the first session, it increased to 97.5% after the second session. A first-month follow-up could be made in 84.6% of the treated patients, and recurrence was observed in no patients. Conclusion: US-guided thrombin injection for PSAs has a high success rate. It is practical, relatively rapid to perform, has low complication rates, and may be selected as the first treatment choice for PSA.