Percutaneous Thrombin Injection For Treatment Research Articles

US-Guided Percutaneous Thrombin Injection Of Upper Extremity Pseudoaneurysms

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.

Combined percutaneous thrombin injection and coil embolization of an inferior thyroid artery pseudoaneurysm

A 54-year-old white man with diabetic renal insufficiency presented with a slowly growing pulsating neck mass after percutaneous internal jugular vein catheterization for hemodialysis. Contrast-enhanced computed tomography showed a pseudoaneurysm of the inferior thyroid artery. After unsuccessful transcatheter coil embolization percutaneous ultrasound guided thrombin injection was performed, with complete thrombosis of the pseudoaneurysm. Percutaneous thrombin injection for treatment of a pseudoaneurysm of the inferior thyroid artery has not been described so far to our best of knowledge.

Percutaneous Thrombin Injection for Treatment of Iatrogenic Femoral Artery Pseudoaneurysms: A Case for Caution

The case of a patient who developed a femoral artery pseudoaneurysm following cardiac catheterization is described. After 2 failed attempts of ultrasound-guided compression repair, the patient underwent percutaneous thrombin injection with, beside of complete closure of the pseudoaneurysm, a severe limb ischemia due to distal thrombin migration with consecutive clot formation finally resulting in thigh amputation of the affected leg. Indications, advantages, and disadvantages of various options for the treatment of iatrogenic femoral artery pseudoaneurysms (vascular surgery, ultrasound-guided compression, percutaneous thrombin injection, and other nonsurgical treatment modalities), as well as risk factors for distal migration of liquid thrombin after percutaneous injection, are discussed in this report.

A prospective study on ultrasound-guided percutaneous thrombin injection for treatment of iatrogenic post-catheterisation femoral pseudoaneurysms

Background The purpose of this study was to evaluate prospectively the safety and efficacy of bovine thrombin injection for the treatment of iatrogenic post-catheterisation pseudoaneurysms. Methods and results A total of 274 patients (90 women, 184 men, 69.8 ± 7 years) with iatrogenic femoral pseudoaneurysms were treated by ultrasound-guided thrombin injection (UGTI). The deepest pseudoaneurysm chamber was entered with a 0.90 × 40 mm or 90 mm needle and bovine thrombin (solution of 1000 U/ml) was injected. Pseudoaneurysms were associated with diagnostic cardiac catheterisation, percutaneous coronary intervention or invasive electrophysiologic investigation. The majority of the patients were under antiplatelet therapy with aspirin or clopidogrel or both, and additional low dose heparin therapy. A total of 52 patients were treated with either phenprocoumon or enoxaparine body weight adjusted. UGTI was primary successful in 267 of 274 patients (97%). In 3 of 7 patients with a remaining pseudoaneurysm a second injection was required. Three patients were treated by ultrasound-guided compression. One patient was treated by surgical repair of the pseudoaneurysm 1 day after UGTI because a further pseudoaneurysm developed under phenprocoumon therapy. UGTI-related complications such as significant arterial thrombotic events or allergic reactions did not occur. 75 patients (27%) were evaluated by an additional sonography after 3 months to assess the long-term effect. Conclusion UGTI was well tolerated, safe and primarily effective in 97% of patients with iatrogenic femoral pseudoaneurysms. Anticoagulant use did not hinder successful thrombosis. UGTI should be considered as first-line therapy for the treatment of post-catheterisation pseudoaneurysms.

Percutaneous Thrombin Injection for Treatment of a Splenic Artery Aneurysm

Splenic artery aneurysms are an uncommon entity and are usually asymptomatic when diagnosed. Treatment is based on size, with aneurysms greater than 2 cm usually undergoing surgical repair. We present a case in which percutaneous thrombin injection was used for treatment of a splenic artery aneurysm.

Percutaneous thrombin injection for treatment of a splenic artery aneurysm

Percutaneous thrombin injection for treatment of a splenic artery aneurysm

Postcatheterization Pseudoaneurysm: Results of US-guided Percutaneous Thrombin Injection in 240 Patients

To prospectively evaluate ultrasonographically (US) guided percutaneous thrombin injection for treatment of femoral artery and brachial artery pseudoaneurysms. The university institutional review board approved the study. Informed consent was obtained from all patients. Two hundred forty patients with postcatheterization femoral artery (n = 132) or brachial artery (n = 8) pseudoaneurysms were treated with US-guided bovine thrombin (1.000 IU/mL) injection. At diagnosis, 107 (44.6%) patients received anticoagulation therapy; 159 (66.2%), antiplatelet therapy; and 76 (31.7%), both therapies. Pseudoaneurysm size, length and width of pseudoaneurysm neck, thrombin dose, therapy outcome, and complications were documented. The peak blood flow in peripheral arteries was determined before and after thrombin injection. Follow-up duplex US was performed 12-24 hours, 5-7 days, and 21-25 days after treatment. A nonpaired t test was used to compare differences in age between the male and female patients. Two-way analysis of covariance was performed to analyze the influences of factors that may have been related to the amount of thrombin used. Mean pseudoaneurysm volume was 4.69 cm3 +/- 5.49 (standard deviation). Simple and complex pseudoaneurysms were treated in 165 and 75 patients, respectively. A total of 260 thrombin injections were performed: 1.04 injections per patient with a simple pseudoaneurysm and 1.17 injections per patient with a complex pseudoaneurysm. The mean injected thrombin dose was 425.31 IU +/- 341.75 for all pseudoaneurysms, 382.12 IU +/- 281.00 for simple pseudoaneurysms only, and 520.33 IU +/- 434.64 for complex pseudoaneurysms only. There was only a computational correlation between pseudoaneurysm size and thrombin dose (r2 = 0.07). The primary success rate was 93.8% overall, 95.8% for simple pseudoaneurysms, and 89% for complex pseudoaneurysms. The secondary success rate was 99.6% overall, 100% for simple pseudoaneurysms, and 99% for complex pseudoaneurysms. Early (at < or =24 hours) reperfusion occurred in one simple and five complex pseudoaneurysms. Four late reperfusions-two in simple and two in complex pseudoaneurysms-were detected at 1-week follow-up; no late reperfusions were detected at 3 weeks. Thromboembolic complications occurred in two patients and resolved spontaneously. One mild allergic reaction and no infections occurred. US-guided percutaneous thrombin injection enables successful, safe management of postcatheterization pseudoaneurysms.

Prolonged Generalized Urticarial Reaction after Percutaneous Thrombin Injection for Treatment of a Femoral Artery Pseudoaneurysm

Prolonged Generalized Urticarial Reaction after Percutaneous Thrombin Injection for Treatment of a Femoral Artery Pseudoaneurysm