Abstract
Introduction:Arterial pseudoaneurysms (PSAs) are the most common access site complication following transarterial catheter intervention. Ultrasound-guided injection of thrombogenic substances into perfused arterial PSAs followed by compression therapy is a well-established and less invasive treatment option than surgical repair. Different agents are available to induce thrombosis including thrombin and a fibrin-based tissue glue, which is used as first-line treatment at our institution. This paper deals with our experience using ultrasound-guided fibrin glue injection (UGFI).Materials and Methods:Retrospective data analysis: all patients (55) treated for iatrogenic femoral PSA following digital subtraction angiography of the lower extremities between January 1, 2010, and December 31, 2018, were included. Data on epidemiology, PSA location and size, vascular risk factors, fibrin glue injection (fibrin glue volume), primary success rate of UFGI, and complications related to the treatment were analyzed.Results:A total of 55 consecutive femoral iatrogenic PSAs were treated during the defined period and 32 (58.2%) of the patients were female. Imaging was performed using ultrasound in all cases. The most common PSA location (80.0%) was the common femoral artery, mean PSA size (± SD) was 2.7 ± 1.2 cm, and neck length was 1.6 ± 1.0 cm. The dose (mean ± SD) of fibrin glue was 2.6 mL (± 1.0; maximum: 6 mL). Primary UGFI success rate was 87.3% and conversion rate to open surgery was 12.7%. Two (4%) patients required embolectomy for peripheral embolization after UGFI.Conclusion:Early results achieved with UGFI for treatment of iatrogenic femoral PSA are promising. In our cohort, UGFI was a safe and effective first-line alternative to traditional open surgery, which then was unnecessary in the vast majority of PSA cases. Further prospective studies for comparison of ultrasound-guided techniques should be encouraged.
Highlights
Arterial pseudoaneurysms (PSAs) are the most common access site complication following transarterial catheter intervention
Primary end point was complete thrombosis of the femoral PSA confirmed by duplex ultrasound (DUS), which was performed within 24 hours after ultrasound-guided fibrin glue injection (UGFI); secondary end points were rates of re-intervention and complications
Fifty-five patients with PSA and UGFI treatment were included for analysis
Summary
Arterial pseudoaneurysms (PSAs) are the most common access site complication following transarterial catheter intervention. Ultrasound-guided injection of thrombogenic substances into perfused arterial PSAs followed by compression therapy is a well-established and less invasive treatment option than surgical repair. This paper deals with our experience using ultrasound-guided fibrin glue injection (UGFI). Access site complications following percutaneous interventions include bleeding as well as ischemic complications. Additional invasive procedures are required for treatment of these complications and potentially lead to an increase in morbidity and length of hospital stay.[1,2] Arterial pseudoaneurysms (PSAs) are the most frequent complication following percutaneous interventions, occurring with an incidence of 0.2% to 5.0%.3,4. As a result of disruption of the vessel wall, for example, after percutaneous puncture of the artery to gain access for endovascular interventions, insufficient hemostasis leads to extravasation of blood to the perivascular tissue. The PSA is connected to the original artery by a “neck” and surrounded by adventitia and soft tissue.[5]
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