US-Guided Percutaneous Thrombin Injection Of Upper Extremity Pseudoaneurysms

Abstract

Objectives: While percutaneous thrombin injection for treatment of lower extremity pseudoaneurysms (PSA) is well documented, little has been published regarding this technique in the upper extremity. The purpose of this investigation was to evaluate the safety and effectiveness of ultrasonography-guided (US-guided) percutaneous thrombin injection for the treatment of upper extremity brachial and radial artery PSAs. Methods: Retrospective single institution study from January 2009 to December 2012. Demographics, PSA size, thrombin dose, therapy outcome, and complications were documented. Post treatment success was confirmed with Duplex US. Results: Between January 2009 and December 2012, 86 upper extremity arterial duplex ultrasounds were performed for a clinical suspicion of an upper extremity PSA. 18 ultrasounds (20.9%) demonstrated an iatrogenic upper extremity PSA. Mean age was 73.5 6 10.6 years and 67% (n 1⁄4 12) were female. Nine patients (50%) developed a PSA after removal of 6 French sheath, five (28%) after removal of a 5 French sheath, two (11%) following removal of a 4 French sheath, one after failed PICC line insertion and one following removal of a brachial arterial line. Fourteen upper extremity PSAs (77.8%) in 18 patients were treated with US-guided thrombin injection. Three of the 14 (21.4%) were radial artery PSAs and 11 (78.6%) were brachial artery PSAs. Thirteen of the 14 (92.9%) attempts at US-guided thrombin injection were successful with a single injection. The mean injected thrombin dose was 2079 IU (range 300-8000). There were no thrombotic or embolic complications at a mean follow-up of 19.4 months. Conclusions: US-guided thrombin injection is safe and effective for the treatment of iatrogenic brachial and radial artery PSAs.