Percutaneous Thrombin Injection Research Articles

Ultrasound-Guided Percutaneous Thrombin Injection of Common Carotid Pseudoaneurysm following Carotid Endarterectomy is Possible

Pseudoaneurysm (PSA) of the carotid artery is a rare complication of carotid endarterectomy (CEA) with an incidence of less than 1%. PSAs of other named arteries are commonly treated with ultrasound-guided thrombin injection; however, there are few accounts in the literature discussing the use of this technique for the treatment of carotid PSA, specifically, and none for carotid PSA after CEA. We present the case of an 86-year-old woman with a left common carotid artery PSA, which was noted after left CEA. As emergent treatment, ultrasound-guided direct percutaneous thrombin injection was used without embolic protection. This produced immediate thrombosis of the PSA, without complication. Arterial duplex at long-term follow-up demonstrated sustained PSA closure and patency of the carotid artery system. We report our case and review of the very limited available literature on this procedure.

A novel approach to the management of carotid blowout syndrome: the use of thrombin in a case of failed covered stenting

Acute hemorrhage relating to an expanding pseudoaneurysm of the carotid artery is referred to as carotid blowout syndrome (CBS). CBS is associated with a high morbidity and mortality. We describe...

Repair of a thrombosed pseudoaneurysm that developed after puncture for an arterial blood gas using a vein graf

Pseudoaneurysms involving the leakage of blood between the arterial wall and the peripheral parenchyma can occur as a result of an artery’s perforation. In this case report, we present a repair, using a vein graft, of a thrombosed pseudoa- neurysm that developed in a radial artery after a single puncture to obtain a sample for the determination of arterial blood gases. A 56-year-old female patient was admitted with a mass in her left wrist on the radial side. Upon examination, a sen- sitive and mobile mass was detected by palpation. The patient had no fever or any other symptoms of inflammation. Her detailed anamnesis revealed that the mass had developed after a puncture to obtain a blood sample for an arterial blood gas measurement. By using magnetic resonance imaging the mass was determined to be a thrombosed pseudoaneurysm. The mass was excised and the gap that had developed in the radial artery was repaired with a vein graft obtained from the forearm. Magnetic resonance angiography imaging after 1 month confirmed the vein graft’s patency. Cannulations for blood monitoring, blood gas analysis and interventional radiological procedures are indispensable processes used in medicine; however, they are not risk-free. Following these procedures, thromboses and pseudoaneurysms can develop. A number of treatment options exist, including bandaging, percutaneous thrombin injections, and surgical treatment for complicated cases. For pseudoaneurysms that create a mass effect, as in our case, surgery is needed. Such complications after interventional procedures involving the radial artery should be kept in mind.

Complications of percutaneous thrombin injection in patients with postcatheterization femoral pseudoaneurysm.

To study the complications of ultrasound-guided thrombin injection of pseudo-aneurysms occurring after interventional cardiovascular procedures. We prospectively studied 353 patients who developed post-catheterization femoral artery pseudo-aneurysms and were treated with ultrasound-guided thrombin injection. Arterial micro-embolization occurred in 53 patients (15%) and pulmonary embolism in 1 patient (0.3%). None of the patients developed significant peripheral arterial embolism. The length of the communicating channel between the arterial lumen and the pseudo-aneurysm was inversely correlated with the risk of embolization (p < 0.0001). A 4.6 mm increase in channel length decreased the odds of embolization by 14%, and patients with a channel less than 2 mm long were at greater risk. Repeated thrombin injection also increased the risk of embolization (p = 0.02). Thrombin injection for the treatment of post-catheterization femoral pseudo-aneurysm is feasible and safe, but it must be performed with caution, especially when the sac is directly communicating with the artery, or when success cannot be achieved with a single injection.

Ultrasound guided percutaneous thrombin injection for the management of a large peripancreatic pseudoaneurysm

Ultrasound guided percutaneous thrombin injection for the management of a large peripancreatic pseudoaneurysm

Ultrasound-Guided Percutaneous Thrombin Injection for Post-Catheterization Pseudoaneurysm

The efficacy and safety of ultrasound-guided thrombin injection (UGTI) for the treatment of post-catheterization femoral and brachial artery pseudoaneurysms (PSA) is unclear in Japan. A retrospective study of 32 consecutive patients undergoing percutaneous UGTI of post-catheterization PSA between February 2011 and February 2014 was performed. There were 23 femoral PSA and 9 brachial PSA treated with UGTI. The prevalence of CAD and smoking history were higher in the brachial PSA patients, but there were no statistically significant differences in other patient demographic factors or in the preprocedural antiplatelet therapy between the femoral and brachial PSA patients. The median dose of thrombin injected was 200 U (range, 100-600 U). The initial success rate, early recurrence rate and surgical conversion rate were 91%, 0% and 4% in the femoral PSA, and 89%, 11% and 11% in the brachial PSA, respectively. There were 2 cases of medial nerve compression in the brachial PSA group, but there were no complications in the femoral PSA group (P=0.0198). On outpatient clinical follow-up in the successfully treated patients, there were no recurrences after an average follow-up of 16 months. UGTI is a feasible, safe and effective less-invasive treatment for post-catheterization PSA. Brachial PSA, however, might require additional attention because of their tendency toward higher recurrence and complications.

Endovascular Management of Visceral Arterial Aneurysms

Visceral artery aneurysms are rare entities involving the celiac, superior mesenteric or inferior mesenteric arteries and their branches. While the natural history of these aneurysms is not well known as many are found incidentally, a definite risk of rupture and subsequent mortality has been demonstrated. There are several endovascular methods that an operator may choose to treat visceral artery aneurysms, and selection of the appropriate technique depends on the type and size of aneurysm and the anatomy of the affected artery. It is the aim of this paper to describe the indications, technical considerations and endovascular methods of treatment of visceral artery aneurysms and pseudoaneurysms. The following techniques of angiographic intervention are presented and discussed: isolation, covered stents, coil packing, liquid embolic agents and percutaneous thrombin injection. Where appropriate, individual aneurysm and artery specific treatment considerations are emphasized. To guide and assist practice, a suggested treatment algorithm is presented.

Posttraumatic pseudoaneurysm of medial plantar artery in a child: treatment with percutaneous thrombin injection

Pseudoaneurysms of the medial plantar artery are rare. The authors describe a case of a pseudoaneurysm of the medial plantar artery of a child who had suffered a penetrating laceration injury. Diagnosis can be confirmed using Doppler ultrasound and magnetic resonance angiography. As an alternative to the conventional surgery technique, percutaneous Doppler ultrasound-guided thrombin injection is a safe and effective treatment.

Ultrasound-guided percutaneous thrombin injection of iatrogenic upper extremity pseudoaneurysms

The objective of this study was to evaluate the safety and efficacy of ultrasound-guided thrombin injection (TI) for the treatment of upper extremity iatrogenic pseudoaneurysms (PAs) after percutaneous upper extremity arterial access. This is a retrospective single-institution study from January 2009 to December 2012. All patients with clinical suspicion of an upper extremity PA after arterial puncture underwent duplex examination. Patients with and without PAs were compared to identify risk factors for development of PAs. Outcomes were analyzed in those patients with PAs that were treated with TI. Between January 1, 2009, and December 31, 2012, there were 61 upper extremity arterial duplex examinations performed for a clinical suspicion of an upper extremity PA. Eighteen ultrasound examinations (29.5%) demonstrated an iatrogenic upper extremity PA (13 brachial and five radial). Those patients with an upper extremity PA were more likely to have a history of hypertension, atrial fibrillation, and chronic kidney disease. Sheath size, preprocedural antiplatelet therapy, periprocedural anticoagulation regimen, service specialty performing the procedure, and procedure type did not influence the development of PA. Of 18 patients with PA, 14 were treated with TI with an overall success rate of 86%. There was one PA that failed to thrombose with TI, and there was one native brachial artery thrombosis requiring emergent surgical intervention. Outpatient clinical follow-up in the successfully treated patients demonstrated no recurrences at an average follow-up of 8 months. Ultrasound-guided percutaneous TI appears safe and effective for the treatment of iatrogenic brachial and radial artery PAs.

Traumatic axillary artery pseudoaneurysm treated with intravascular balloon occlusion and percutaneous thrombin injection

Axillary artery pseudoaneurysms are relatively rare, with few reported cases found in the literature. Furthermore, treatment with percutaneous thrombin injection has not yet been reported. We report the case of a 59-year-old man with a large (10 cm) post-traumatic pseudoaneurysm of the left axillary artery found five weeks after a motorcycle crash. The patient sustained multiple injuries, including fractures of the left scapula and clavicle. Edema was observed at the time of diagnosis. Arteriography with successful ultrasound-guided percutaneous thrombin injection was undertaken. The patient experienced no complications after the procedure.

Percutaneous Thrombin Injection with Balloon Occlusion for the Treatment of a Femoral Artery Pseudoaneurysm

Correspondence to Jeong Hun Shin, M.D., Ph.D. Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri 471-701, Korea Tel: +82-31-560-2599, Fax: +82-31-560-2598, E-mail: cardio.hyapex@gmail.com Copyrightc 2014 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 대퇴동맥 가성동맥류의 풍선 차단법을 이용한 트롬빈 주입요법 치료 1예

Percutaneous ultrasound-guided thrombin injection is effective even in infants with external iliac artery pseudoaneurysms.

Iatrogenic pseudoaneurysms are extremely rare in children. Conventional management of pseudoaneurysms in adults has included surgical repair, ultrasound-guided compression, and more recently, endovascular embolization. However, in infants and children, there is little information regarding the applicability of such treatment modalities, which have been effective in adults, because of its rarity. Here, we present the case of a 6-month-old infant who developed a postprocedural pseudoaneurysm of the external iliac artery, which was successfully treated with ultrasound-guided percutaneous thrombin injection.

Percutaneous Embolization of a Hepatic Artery Pseudoaneurysm under Combined Angiographic and Fluoroscopic Guidance

Hepatic artery pseudoaneurysm is a rare complication of liver directed procedures. Several strategies for treatment of pseudoaneurysms have been described. We describe a challenging case in which a small bleeding hepatic artery pseudoaneurysm is complicated by a proximal hepatic arterial occlusion, preventing transcatheter access. The aneurysm was too small to be seen on ultrasound. Using combined angiographic and fluoroscopic guidance, however, the aneurysm was triangulated and successfully treated with percutaneous direct thrombin injection. Combined angiography and fluoroscopy guided percutaneous thrombin injection of intrahepatic pseudoaneurysms can be a valuable treatment approach, particularly when other methods are not feasible or have failed.

A cost effective endovascular approach for management of post-catheterization profunda femoris artery pseudoaneurysm using thrombin

Post-catheterization PSA is one of the most commonly encountered vascular complications of cardiac and peripheral angiographic procedures. We report the case of patient who developed deep-seated profunda femoris artery pseudoaneurysm (PSA) following cardiac catheterization. Despite, repeated ultrasound guided compressions the PSA failed to close and instead produced local site pressure ulcers. The secondary infection followed which precluded use of percutaneous thrombin injection. The PSA was finally closed via a total endovascular technique combining intravascular thrombin injection and coil embolization, thus obviating the need for expensive measures like cover stents or invasive surgical repairs.

Treatment for femoral pseudoaneurysms.

Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, but sometimes definitive treatment is needed. Surgery has traditionally been considered the 'gold standard' treatment, although it is not without risk in patients with severe cardiovascular disease. Less invasive treatment options such as Duplex ultrasound-guided compression and percutaneous thrombin injection are available, however, evidence of their efficacy is limited. This is an update of a Cochrane review first published in 2006. To assess the effects of different treatments for femoral pseudoaneurysms resulting from endovascular procedures, specifically assessing less invasive treatment options such as blind manual or mechanical compression, ultrasound-guided compression, or percutaneous thrombin injection. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2013) and CENTRAL (2013, Issue 9). Randomised controlled trials (RCTs) comparing two treatments for femoral pseudoaneurysms following vascular interventional procedures were considered for inclusion in the review. Four studies were included in the analyses comparing: manual compression versus ultrasound-guided compression; ultrasound-guided application of a mechanical device (FemoStop) versus blind application; and ultrasound-guided compression versus percutaneous thrombin injection (two studies). There were no studies with a surgical intervention arm. Data were extracted independently by both authors. Compression (manual or FemoStop) was effective in achieving pseudoaneurysm thrombosis although ultrasound-guided application failed to confer any benefit (risk ratio (RR) 0.96; 95% confidence interval (CI) 0.88 to 1.04).Percutaneous thrombin injection was more effective than a single session of ultrasound-guided compression in achieving primary pseudoaneurysm thrombosis within individual RCTs but merged data failed to show statistical significance (RR 2.81; 95% CI 0.44 to 18.13). There was no statistically significant difference in the length of hospital stay between the two groups and no complications were reported apart from one deep vein thrombosis in the compression group. The limited evidence base appears to support the use of thrombin injection as an effective treatment for femoral pseudoaneurysm. A pragmatic approach may be to use compression (blind or ultrasound-guided) as first-line treatment, reserving thrombin injection for those in whom the compression procedure fails.

Ultrasound‐guided thrombin injection in the treatment of iatrogenic arterial pseudoaneurysms: Single‐center experience

The aim of this study was to assess the safety and efficacy of ultrasound-guided percutaneous thrombin injection for the treatment of postcatheterization arterial pseudoaneurysms. We evaluated retrospectively 82 consecutive subjects treated with percutaneous ultrasound-guided thrombin injection of postcatheterization femoral (n = 79), brachial (n = 2), and radial (n = 1) pseudoaneurysms from January 2006 to April 2012. Pseudoaneurysm size, thrombin dose, and therapy outcome were documented. All pseudoaneurysm sacs were thrombosed with a single injection. The overall primary success rate (complete sac thrombosis) was 92.7%. A 30-day Doppler ultrasound follow-up showed a 100% procedural success. There were no complications.

Percutaneous Thrombin Injection with a Distal Embolic Protection Device for Treatment of a Common Carotid Artery Pseudoaneurysm

Carotid artery pseudoaneurysm is a rare complication from placement of an internal jugular triple lumen catheter. Endovascular stenting is the favored treatment option in the setting of traumatic carotid injury. In other parts of the body, specifically the femoral artery, thrombin injection has become the standard of care. We intend to show that effective management of carotid pseudoaneurysms can also be achieved with thrombin injection after placement of a distal embolic protection device.

Percutaneous thrombin injection in an infant to treat hepatic artery pseudoaneurysm after failed embolization

Percutaneous thrombin injection has been described in case reports as an alternative to surgical intervention for the treatment of hepatic artery pseudoaneurysms associated with high-grade liver lacerations in adults. However, there is limited description in the literature of this technique being applied in children, particularly in preadolescents, and no published literature describes its use in infants. The procedure can be performed by pediatric radiologists and pediatric interventional radiologists skilled in ultrasound-guided aspiration techniques. We report successful application of percutaneous thrombin injection in an infant to treat a pseudoaneurysm of a left hepatic arterial branch in an 11-month-old girl with a grade IV liver laceration after superselective transcatheter arterial embolization failed to achieve thrombosis.

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.

Post-traumatic pseudoaneurysm of the thyrocervical trunk

Pseudoaneurysms of the thyrocervical trunk or its branches are extremely rare. They are often the result of a penetrating injury and commonly iatrogenic in origin. Pseudoaneurysm formation following blunt trauma has twice been reported in the English-language literature. We report a case of a 56-year-old man involved in a motor vehicle collision who presented with a slowly growing mass over the course of 4months. A magnetic resonance (MR) examination was requested to evaluate the cause of this slowly growing mass. Our case is unique in that MR imaging correctly diagnosed the lesion, which was subsequently treated with ultrasound-guided percutaneous thrombin injection. Our case is the only published instance of treatment of a thyrocervical trunk pseudoaneurysm by direct ultrasound-guided percutaneous thrombin injection.