Treatment Of Iatrogenic Femoral Pseudoaneurysms Research Articles

Treatment of iatrogenic femoral pseudoaneurysms with percutaneous thrombin injection: experience in 54 patients.

To assess the clinical success of ultrasonography (US)-guided thrombin injection for the treatment of iatrogenic femoral pseudoaneurysms and to identify criteria that may predispose to treatment failure. Fifty-four iatrogenic femoral pseudoaneurysms were treated with US-guided thrombin injection. Forty-five were classified as simple (single lobe) and nine, as complex (at least two lobes and a single neck to the native vessel). Pseudoaneurysm volume, classification, thrombin dose, anticoagulation therapy status, and sheath size were compared between failed and successful cases. Seven- to 10-day follow-up US and a minimum 4-month clinical follow-up were also performed to evaluate success. Fifty of 54 pseudoaneurysms were successfully treated with topical thrombin without complication and included all 45 simple and five of nine complex pseudoaneurysms. US follow-up in all 50 successful cases and clinical follow-up in 37 of these revealed no recurrence. Only a complex pseudoaneurysm classification was significantly associated with failure (P<.01). Among the complex pseudoaneurysms, successful cases involved two injections and a total thrombin dose of at least 1,500 units. In failed cases, pseudoaneurysms were treated with a single injection of 1,000 units, initially thrombosed, and recurred. Simple iatrogenic femoral pseudoaneurysms, regardless of size or concomitant anticoagulation therapy, can be treated with a single injection of up to 1,000 units of topical thrombin and require no follow-up. Complex pseudoaneurysms will likely require a second injection (total thrombin dose of at least 1,500 units) and short-term clinical and US follow-up to ensure successful treatment.

The efficacy of ultrasound-guided compression of iatrogenic femoral pseudo-aneurysms.

to evaluate ultrasound guided compression (UGC) for the treatment of iatrogenic femoral pseudoaneurysms (PA). retrospective follow-up of 130 patients with suspected PA referred from the cardiac catheterisation laboratory over a 36-month period. the overall incidence of PA was 0.5% and was significantly higher after therapeutic (1.5%) than diagnostic (0.3%) procedures (p <0.000001). Forty-eight patients with a PA were treated with UGC with an 88% success rate. Success did not appear to be related to PA diameter. the efficacy of UGC as treatment of PAs is confirmed.

Ultrasound-Guided Thrombin Injection of Iatrogenic Femoral Pseudoaneurysms: A Prospective Analysis

An adverse consequence of the use of the femoral artery for the endovascular evaluation and treatment of arterial disease is the increased incidence of iatrogenic femoral pseudoaneurysms. Although surgical repair has traditionally been used to treat such aneurysms, less invasive modalities have emerged. The purpose of this study is to prospectively evaluate ultrasound-guided thrombin injection (UGTI) for the treatment of iatrogenic femoral pseudoaneurysms. A treatment protocol was approved and 30 stable patients (21 female; age range 43-85 years; mean 67 years) were prospectively enrolled from December 1997 through June 1999 to undergo UGTI on 30 iatrogenic femoral pseudoaneurysms. Pseudoaneurysms occurred after cardiac intervention (n = 22, 73%), peripheral intervention (n = 7, 23%), and after a femoral line placement (n = 1, 3%). They ranged in size from one to 5 cm with a time interval from intervention until UGTI of one to 132 days (median 3 days). Eleven patients (37%) were systematically anticoagulated at the time of UGTI. All pseudoaneurysms were treated using sterile technique and local anesthesia with ultrasound-guided injection via a 20-gauge spinal needle of 0.1 to 2 cm3 (median 0.6 cm3) of 1000 units/cm3 topical thrombin solution administered by one of six physicians. A period of bedrest for 4 to 6 hours after injection was followed by repeat groin duplex scan at 24 hours and a clinical follow-up at 30 days. There were no procedural deaths or nonvascular complications. Twenty-seven (90%) UGTIs resulted in successful pseudoaneurysm ablation with no recurrences at 24 hours or 30 days. Two (7%) UGTIs failed and one (3%) femoral artery embolic complication occurred; all were successfully treated with surgery. Success appeared to be independent of anticoagulation status, pseudoaneurysm age, size, or operator experience. We conclude that UGTI is a safe, easy, well-tolerated and effective noninvasive method for treatment of iatrogenic femoral pseudoaneurysms and should be considered in all stable patients before operative repair.

Ultrasound-Guided Compression for the Treatment of Iatrogenic Femoral Pseudoaneurysms

To assess the emerging use of ultrasound-guided compression (USGC) to treat iatrogenic femoral artery pseudoaneurysm (PA), we reviewed the experience in the accredited vascular laboratory of a large community teaching hospital from June 1993 to August 1994. Femoral duplex ultrasonography was done on 94 consecutive patients suspected of having PA. Twenty-eight PAs were found in 27 patients (14 women and 13 men; mean age, 62 years). Causes included cardiac angiography (n = 9), coronary angioplasty (n = 4), coronary stent placement (n = 12), and peripheral angioplasty (n = 3). Aneurysms were identified 1 to 90 days (median, 6 days) after femoral procedures, and their size ranged from 0.9 cm to 8.0 cm (mean, 2.5 cm). Fifteen patients (53%) were receiving systemic anticoagulation, 7 (25%) had spontaneous resolution, 10 (36%) were treated by femoral stitch arteriorrhaphy, and 11 (39%) were treated by USGC. Compression included vascular surgery standby, identification of PA neck (channel to native artery), 10-minute compression intervals to obliterate flow with a 5 MHz duplex ultrasound probe, and restudy at 24 hours. This protocol resulted in successful thrombosis in 8 patients (73%) but failed in 3 patients (37%), who required operative repair. Large aneurysm size, PA neck size, and systemic anticoagulation did not influence successful compression of PAs. Advanced age of the PA and operator inexperience were factors believed to negatively influence success. These data suggest that USGC is safe and effective and causes less morbidity than traditional repair, and it has emerged as the initial treatment of choice for iatrogenic femoral pseudoaneurysms.