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Stern M, Schremmer J, Scharm S, Baasen S, Heinen Y, Sansone R, Polzin A, Jung C, Heiss C, Kelm M, Busch L. Microvascular tissue perfusion after postcatheterization pseudoaneurysm treatment. Clin Hemorheol Microcirc 2022; 82:275-282. [PMID: 35938240 DOI: 10.3233/ch-221438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Femoral pseudoaneurysm (PSA) is a severe complication after endovascular procedures. Ultrasound-guided manual compression (MC) and percutaneous thrombin injection (TI) are frequently used treatments. MC is less effective, TI may cause thromboembolic events. OBJECTIVE Up to date, there is no data regarding impairment of microvascular tissue perfusion after PSA treatment. METHODS In this single-center, prospective study 22 patients with PSA were included. We compared macro- and microcirculatory perfusion in the treated and untreated leg at baseline before, after and one day after treatment. Leg perfusion was assessed with ultrasound and ankle-brachial index (ABI). Microcirculatory perfusion of the feet was measured with a near-infrared spectroscopy (NIRS) camera generating StO2-tissue-maps. RESULTS Successful PSA thrombosis was achieved in 16 (100%) patients in TI group and in 4 (66.7%) patients in MC group. There was no evidence of arterial thrombi on ultrasound and the ABI did not differ between groups. NIRS StO2-tissue-maps of the feet showed no significant difference in both groups concerning the treated (p = 0.121) or the untreated (p = 0.198) leg during follow up. CONCLUSIONS In this small exploratory study, there was no evidence of micro- and macrovascular tissue perfusion impairment after treatment of postcatheterization femoral pseudoaneurysm with thrombin injection underscoring the safety of this approach.
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Affiliation(s)
- M Stern
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - J Schremmer
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - S Scharm
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - S Baasen
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Y Heinen
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - R Sansone
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - A Polzin
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - C Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - C Heiss
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.,Department of Vascular Medicine, Surrey and Sussex NHS Healthcare Trust, Redhill, United Kingdom
| | - M Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID)Duesseldorf, Germany
| | - L Busch
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
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Hayakawa N, Kodera S, Miyauchi A, Hirano S, Sahashi S, Ishibashi N, Kasai Y, Arakawa M, Shakya S, Kanda J. Effective treatment of iatrogenic femoral pseudoaneurysms by combined endovascular balloon inflation and percutaneous thrombin injection. Cardiovasc Interv Ther 2021; 37:158-166. [PMID: 33576932 DOI: 10.1007/s12928-021-00764-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/29/2021] [Indexed: 11/29/2022]
Abstract
The increasing number of percutaneous endovascular procedures in highly anticoagulated patients has increased the possibility of iatrogenic femoral artery pseudoaneurysm (IFAP). Ultrasound (US)-guided percutaneous thrombin injection is one of the feasible treatments; however, there are concerns about complications such as peripheral embolization. This study was performed to examine the efficacy and safety of treatment of IFAPs using a combination of percutaneous thrombin injection and intravascular balloon inflation. In this retrospective, single-center study, we analyzed 11 patients who developed and were treated for IFAPs from January 2017 through April 2020. The patients were treated with endovascular therapy (EVT) with percutaneous thrombin injection. The technique utilized fluoroscopic guidance to place a balloon at the neck of the IFAP, and the balloon was then inflated to prevent the inflow of blood to the aneurysm. We then performed US-guided thrombin injection. The mean age was 72.36 ± 10.43 years; mean body mass index (BMI) was 25.25 ± 3.18. All patients had hypertension, 72.7% were undergoing hemodialysis, and 54.5% used oral anticoagulant drugs. The mean aneurysm size was 24.34 ± 13.54 mm. The approach was transfemoral in ten patients and transradial in one patient. All procedures were successful, and there were no complications. The mean thrombin dose was 677.3 ± 410.7 IU; the total hemostatic time was 45.4 ± 24.9 min. In conclusion, the combination of percutaneous thrombin injection and endovascular balloon inflation was feasible and safe for the treatment of IFAPs. This technique may contribute to the treatment of IFAPs.
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Affiliation(s)
- Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan.
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan
| | - Ayako Miyauchi
- Department of Physiology, Asahi General Hospital, Chiba, Japan
| | - Satoshi Hirano
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Shuichi Sahashi
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Noriyuki Ishibashi
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Yuhei Kasai
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Masataka Arakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Sandeep Shakya
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Junji Kanda
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
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Herold J, Peters S, Juenger J, Udelnow A, Kropf S, Bauersachs R, Braun-Dullaeus R. High incidence of deep vein thrombosis during the treatment of pseudoaneurysms - a retrospective nonrandomized study. VASA 2021; 50:231-239. [PMID: 33435750 DOI: 10.1024/0301-1526/a000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Pseudoaneurysms (PSAs) are concerning complications after arterial invasive interventions. Therapeutic options include manual ultrasound-assisted compression, pressure dressings, surgical intervention and thrombin injection. Compression of neighboring veins is obvious. However, the incidence of deep vein thrombosis (DVT) in patients with PSA has not previously been investigated. Patients and methods: In this retrospective, nonrandomized study 238 patients with PSA were analyzed from 2013 to 2018. In 149 patients, all of the parameters were complete for participating. PSAs were treated according to the local standard therapy with either ultrasound-guided compression followed by compression bandage or thrombin injection. Treatment success was evaluated 24 hours later, and the venous system was examined for the presence of DVT. Results: Peripheral DVT was found in 25.4% patients after ultrasound-assisted compression and subsequent pressure bandages, but only 6.4% of patients had DVT after thrombin injection (p = 0.013). Lower leg veins, particularly veins of the crural muscles, were primarily affected. Significantly more PSAs were successfully treated without the occurrence of DVT in the thrombin injection group compared to the compression group (93.6 vs. 69.0%; p = 0.001). Conclusions: Our study revealed that the use of thrombin injections resulted in a significantly lower rate of postinterventional DVT and a higher total number of successfully treated PSAs compared to compression therapy.
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Affiliation(s)
- Joerg Herold
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Germany.,Department of Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Germany
| | - Sophie Peters
- Department of Surgery, Dietrich Bonhoeffer Diakonie Hospital, Neubrandenburg, Germany
| | - Jonas Juenger
- Children's Hospital Prinzessin Margaret, Darmstadt, Germany
| | - Andrej Udelnow
- Brandenburg Medical School "Theodor Fontane", Municipal Hospital of Brandenburg/Havel, Dpt. of Vascular and Endovascular Surgery, Brandenburg/Havel, Germany
| | - Siegfried Kropf
- Institute for Biometry and Medical Informatics, Otto-von-Guericke University Magdeburg, Germany
| | - Rupert Bauersachs
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Germany
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Albarrán-Tamayo F, Murillo-Ortiz B, González Amaro R, López Briones S. Both in vitro T cell proliferation and telomere length are decreased, but CD25 expression and IL-2 production are not affected in aged men. Arch Med Sci 2021; 17:775-784. [PMID: 34025848 PMCID: PMC8130486 DOI: 10.5114/aoms.2019.87593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 06/03/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Aging is a natural process involving dysfunction of multiple organs and is characterized by increased susceptibility to infections, cancer and autoimmune diseases. The functionality of the immune system depends on the capacity of lymphocytes to proliferate in response to antigenic challenges, and telomere length has an important role regulating the number of cell divisions. The aim of this study was to determine the possible relationship between telomere length, interleukin 2 (IL-2) production, CD25 expression and proliferation of peripheral blood mononuclear cells (PBMCs) in aged men. MATERIAL AND METHODS Telomere length was measured by RT-PCR in PBMCs from young and aged men. IL-2 production and CD25 expression were determined by ELISA and flow cytometry, respectively. Cell proliferation was measured by CFSE dilution assays upon in vitro stimulation with concanavalin A (Con A). RESULTS PBMCs from aged men showed a shorter telomere length and a reduced capacity to proliferate in vitro, compared to young men. In contrast, no significant differences in the level of CD25 expression on T lymphocytes, and in vitro production of IL-2 were detected in both groups. In addition, no significant correlation was detected between levels of CD25 expression, IL-2 production, cell proliferation, and telomere length in aged men. CONCLUSIONS In aged men the telomere length shortening and the reduced T cell proliferation are not related to the capacity of IL-2 production and CD25 expression on T lymphocytes.
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Affiliation(s)
| | - Blanca Murillo-Ortiz
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE) No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Guanajuato, México
| | - Roberto González Amaro
- Departamento de Inmunología, Escuela de Medicina, Universidad Autónoma de San Luís Potosí, San Luís Potosí, México
| | - Sergio López Briones
- Departamento de Medicina y Nutrición, División de Ciencias de la Salud, Campus León, Universidad de Guanajuato, León, Guanajuato, México
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Iatrogenic femoral vein pseudoaneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:285-287. [PMID: 32566806 PMCID: PMC7298338 DOI: 10.1016/j.jvscit.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/17/2020] [Indexed: 11/21/2022]
Abstract
Femoral vein pseudoaneurysm is a rare complication during percutaneous interventions. We report the case of a patient with common femoral vein pseudoaneurysm caused by unsuccessful manual compression. A 68-year-old woman underwent catheter ablation for atrial fibrillation at another institution. Postoperatively, she experienced right groin pain and leg edema. Doppler ultrasound examination revealed a 2-cm venous pseudoaneurysm as a compressible and hypoechoic lesion. We successfully performed venous aneurysmectomy after failed ultrasound-guided compression therapy. Appropriate procedures must be selected for patients with femoral pseudoaneurysm. The efficacy of hemostatic techniques for preventing vascular complications after venous sheath removal should not be underestimated.
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Kurzawski J, Janion-Sadowska A, Zandecki L, Sadowski M. Comparison of the Efficacy and Safety of Two Dosing Protocols for Ultrasound Guided Thrombin Injection in Patients with Iatrogenic Femoral Pseudoaneurysms. Eur J Vasc Endovasc Surg 2020; 59:1019-1025. [PMID: 32014339 DOI: 10.1016/j.ejvs.2020.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 12/04/2019] [Accepted: 01/09/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Ultrasound guided thrombin injection (UGTI) is a minimally invasive method of treatment for iatrogenic post-catheterisation femoral pseudoaneurysms (psAs). The optimal dosing protocol for UGTI has not been established. The aim of the study was to compare the success and complication rates between two different dosing protocols (the most commonly used "standard dose protocol" and the "low dose protocol," which is the fractionated administration of smaller thrombin doses of up to 40 IU every 15 s) in patients with a psA with sac volume of ≥1 mL. METHODS This was a retrospective cohort study, and the analysis was performed using a case matching approach based on propensity score. From June 2004 to August 2018, 384 patients who underwent femoral puncture for transcatheter procedures were diagnosed with femoral psA with a sac volume of ≥1 mL and qualified for UGTI. The patients' mean age was 68 (±10.6) years and there were 217 (56.5%) women. To compare protocols, 124 patients treated according to the low dose protocol were nearest neighbour matched according to their propensity score to 124 patients treated according to the standard dose protocol. RESULTS The overall success rate (99.2% vs. 98.4%; p = 1) and success rate of the first UGTI attempt (87.1% vs. 86.3%; p = .85) did not differ between the low dose and standard dose groups. Complications were less common in the low dose group (7.3% vs. 16.1%; p = .03) and the median total amount of thrombin used for procedures was smaller in the low dose group (120 IU vs. 195 IU; p = .01). CONCLUSIONS In patients with femoral psA with sac volume of ≥1 mL, the use of the low dose protocol seemed to be equally effective as the standard dose protocol and was associated with a lower complication rate and reduced thrombin dose.
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Affiliation(s)
| | | | - Lukasz Zandecki
- Jan Kochanowski University, The Faculty of Medicine and Health Sciences, Kielce, Poland.
| | - Marcin Sadowski
- Jan Kochanowski University, The Faculty of Medicine and Health Sciences, Kielce, Poland
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7
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Ha L, Yiu SW, Wang FF, Han JL. A Possible Allergic Reaction Case to Thrombin Injected into Pseudoaneurysm After Radiofrequency Ablation. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1497-1499. [PMID: 31601777 PMCID: PMC6798719 DOI: 10.12659/ajcr.916949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Radiofrequency ablation is a minimally invasive treatment for arrhythmias, including frequent ventricular premature. As a complication of radiofrequency ablation, pseudoaneurysm can be treated conservatively or by ultrasound-guided thrombin injection. CASE REPORT We report a case that a possible allergic reaction to thrombin injected into pseudoaneurysm after radiofrequency ablation. CONCLUSIONS We hope that the report of successful management of the allergic reaction in this case may be of help to other doctors; we also emphasize the importance of checking the patient's history of allergies to thrombin when considering treating pseudoaneurysm with thrombin injection.
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Affiliation(s)
- Lahati Ha
- Department of Cardiology, Peking University Third Hospital, Beijing, China (mainland)
| | - Sze-Wa Yiu
- Department of Cardiology, Peking University Third Hospital, Beijing, China (mainland)
| | - Fang-Fang Wang
- Department of Cardiology, Peking University Third Hospital, Beijing, China (mainland)
| | - Jiang-Li Han
- Department of Cardiology, Peking University Third Hospital, Beijing, China (mainland)
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8
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Abstract
Abstract. In addition to haematoma and arteriovenous fistula, the iatrogenic pseudoaneurysm is a common complication of vascular access that is caused by a perforation in the arterial wall. Iatrogenic pseudoaneurysms can progress in size and lead to rupture and active bleeding. Over the previous few decades, therapeutic methods have evolved from surgical repair to less invasive options, such as ultrasound-guided compression therapy (UGCT) and ultrasound-guided thrombin injection (UGTI). This paper presents an overview of the diagnostic and treatment modalities used in femoral pseudoaneurysms as well as a comprehensive summary of previous studies that analysed the success and complication rates of UGCT and UGTI.
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Affiliation(s)
- Maria Stolt
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Germany
| | | | - Joerg Herold
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Germany
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9
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Yoo T, Starr JE, Go MR, Vaccaro PS, Satiani B, Haurani MJ. Ultrasound-Guided Thrombin Injection Is a Safe and Effective Treatment for Femoral Artery Pseudoaneurysm in the Morbidly Obese. Vasc Endovascular Surg 2017; 51:368-372. [PMID: 28560886 DOI: 10.1177/1538574417708727] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ultrasound-guided thrombin injection (UGTI) is a well-established practice for the treatment of femoral artery pseudoaneurysm. This procedure is highly successful but dependent on appropriate pseudoaneurysm anatomy and adequate ultrasound visualization. Morbid obesity can present a significant technical challenge due to increased groin adiposity, resulting in poor visualization of critical structures needed to safely perform the procedure. We aim to evaluate the safety and efficacy of UGTI to treat femoral artery pseudoaneurysm in the morbidly obese. METHODS This is a retrospective cohort study in which all patients who underwent UGTI at The Ohio State University Ross Heart Hospital from 2009 to 2014 were analyzed for patient characteristics and stratified by body mass index (BMI). Patients with BMI ≥ 35 were considered morbidly obese and were compared to patients with a BMI < 35. Outcome was failed treatment resulting in residual pseudoaneurysm. RESULTS Our cohort consisted of 54 patients who underwent thrombin injection. There were 41 nonmorbidly obese and 13 morbidly obese patients. Mean age was 64.5 years. The cohort was 44.4% male. There were 6 failures, of which 1 underwent successful repeat injection and 5 underwent open surgical repair. There was no statistically significant difference in failure between nonmorbidly obese and morbidly obese patients (9.8% vs 15.4%, P = .45). There were no embolic/thrombotic complications. CONCLUSION Ultrasound-guided thrombin injection is a safe and effective therapy in the morbidly obese for the treatment of femoral artery pseudoaneurysm. In the hands of experienced sonographers and surgeons with adequate visualization of the pseudoaneurysm sac, UGTI should remain a standard therapy in the morbidly obese.
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Affiliation(s)
- Taehwan Yoo
- 1 Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Jean E Starr
- 1 Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Michael R Go
- 1 Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Patrick S Vaccaro
- 1 Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Bhagwan Satiani
- 1 Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Mounir J Haurani
- 1 Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, OH, USA
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Kurzawski J, Sadowski M, Janion-Sadowska A. Complications of percutaneous thrombin injection in patients with postcatheterization femoral pseudoaneurysm. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:188-195. [PMID: 26179719 DOI: 10.1002/jcu.22274] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To study the complications of ultrasound-guided thrombin injection of pseudo-aneurysms occurring after interventional cardiovascular procedures. METHOD We prospectively studied 353 patients who developed post-catheterization femoral artery pseudo-aneurysms and were treated with ultrasound-guided thrombin injection. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Jacek Kurzawski
- Świȩtokrzyskie Cardiology Center, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Marcin Sadowski
- Świȩtokrzyskie Cardiology Center, Grunwaldzka 45, 25-736 Kielce, Poland
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Chen DH, Sammel AM, Jain P, Jepson NS. Cardiologist operated ultrasound guided thrombin injection as a safe and efficacious first line treatment for iatrogenic femoral artery pseudoaneurysms. Heart Lung Circ 2014; 24:165-72. [PMID: 25201028 DOI: 10.1016/j.hlc.2014.07.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/19/2014] [Accepted: 07/21/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of ultrasound guided thrombin injection (UGTI) as a first line treatment for post arterial cannulation iatrogenic femoral artery pseudoaneurysms (IFAP). BACKGROUND IFAPs complicate up to 1% of diagnostic and 8% of interventional cardiac catheterisation procedures. UGTI remains a second line or non-attempted treatment after ultrasound guided manual compression (UGMC) and surgical repair in many centres. METHODS A retrospective review was undertaken of 121 consecutive patients who received UGTI as a first line treatment for IFAPs following cardiac diagnostic, interventional or catheter ablation procedures between 1999 and 2011 at our centre. The mean patient age was 70.7 years and 63% were male. At the time of injection, 89% were on at least one antiplatelet or anticoagulant. Pseudoaneurysms had a mean maximum dimension of 26.7mm (range 10-122mm) and 25% were multilobed. UGTI was performed by an interventional cardiologist with a mean bovine thrombin dose of 648 IU (range 50-5000 IU). RESULTS Primary success, defined as immediate IFAP thrombosis with UGTI, was achieved in 111 (92%) patients. Recurrence occurred in seven patients, three of whom required surgical repair. Multilobed IFAPs had significantly lower primary success rates than unilobed IFAPs (80% vs. 96%, p=0.016). Antiplatelet and anticoagulant use and IFAP size did not significantly affect outcomes. UGTI was not associated with any serious complications (such as thromboembolism, aneurysm rupture, venous thrombosis or abscess formation). CONCLUSION Interventional cardiologist operated UGTI should be considered as a first line therapy for uncomplicated IFAPs following interventional and diagnostic cardiac procedures. Despite high rates of concomitant antiplatelet and antithrombotic therapy, initial thrombosis rates exceeded 90% and we did not experience serious complications.
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Affiliation(s)
- Daniel H Chen
- Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia.
| | - Anthony M Sammel
- Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia; Prince of Wales Clinical School, University of New South Wales, Australia
| | | | - Nigel S Jepson
- Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia; Prince of Wales Clinical School, University of New South Wales, Australia
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Dzijan-Horn M, Langwieser N, Groha P, Bradaric C, Linhardt M, Böttiger C, Byrne RA, Steppich B, Koppara T, Gödel J, Hadamitzky M, Ott I, von Beckerath N, Kastrati A, Laugwitz KL, Ibrahim T. Safety and efficacy of a potential treatment algorithm by using manual compression repair and ultrasound-guided thrombin injection for the management of iatrogenic femoral artery pseudoaneurysm in a large patient cohort. Circ Cardiovasc Interv 2014; 7:207-15. [PMID: 24692534 DOI: 10.1161/circinterventions.113.000836] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because of the risk of associated complications, femoral pseudoaneurysm (PSA) formation implies further treatment. Ultrasound-guided thrombin injection (UGTI) is becoming the accepted gold standard, but manual compression (MC) represents an established treatment option including PSAs not feasible for UGTI. This study aims to assess our experience in PSA treatment using MC or UGTI according to a potential algorithm based on morphological properties in a large patient cohort. METHODS AND RESULTS Between January 2007 and January 2011, a total of 432 PSAs were diagnosed in 29091 consecutive patients (1.49%) undergoing femoral artery catheterization. When compressible, small PSAs (<20 mm), PSAs without clearly definable neck, PSAs directly adjacent to vessels, and PSAs with concomitant arteriovenous fistula were referred to MC (n=145, 34%). All other PSAs were treated by UGTI (n=287, 66%). Follow-up duplex scans were performed within 12 to 14 hours after manual compression therapy and within 4 to 6 hours after UGTI or by the next morning and were available for 428 patients (99.1%). The overall success rate of our institutional therapeutic approach was 97.2%, which was achieved by 178 MC- and 357 UGTI-procedures, respectively. Procedural complications occurred in 5 cases (1.4%) after UGTI and in 3 cases (1.7%) after MC, respectively. The treatment algorithm was not successful in 12 patients, whereas 2 PSAs (0.5%) were successfully excluded by implantation of a covered stent-graft, and 10 patients necessitated surgical intervention (2.3%), which was associated with a high complication rate (30%). CONCLUSIONS The presented treatment algorithm facilitates effective and safe PSA elimination.
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Affiliation(s)
- Marijana Dzijan-Horn
- From the I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (M.D.-H., N.L., P.G., C. Bradaric, N.v.B., K.-L.L., T.I.); Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (M.L., C. Böttiger, R.A.B., B.S., T.K., J.G., M.H., I.O., A.K.); and DZKH (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (M.D.-H., N.L., P.G., C. Bradaric, M.L., C.Böttiger, R.A.B., B.S., T.K., J.G., M.H., I.O., N.v.B., A.K., K.-L.L., T.I.)
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van Helden EJ, Eefting D, Florie J, Verhagen HJM, Moelker A. Endovascular Salvage of a False Aneurysm of the Posterior Tibial Artery Caused by a Stab From a Stingray. Cardiovasc Intervent Radiol 2013; 38:498-500. [DOI: 10.1007/s00270-013-0817-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 11/17/2013] [Indexed: 10/25/2022]
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14
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Santos MB, Silva S, Bettencourt V, Teles RC, Almeida MS, Medeiros D, Silva JA. Ultrasound-guided thrombin-gelatin injection is effective for the treatment of iatrogenic femoral artery pseudoaneurysms: Initial results. Catheter Cardiovasc Interv 2012; 81:303-7. [DOI: 10.1002/ccd.24330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 01/07/2012] [Indexed: 11/09/2022]
Affiliation(s)
| | - Sergio Silva
- Department of Vascular Surgery; Egas Moniz Hospital; Lisbon; Portugal
| | - Vitor Bettencourt
- Department of Vascular Surgery; Egas Moniz Hospital; Lisbon; Portugal
| | | | | | - Duarte Medeiros
- Department of Vascular Surgery; Egas Moniz Hospital; Lisbon; Portugal
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