Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms

Purpose: We previously reported preliminary data on a new procedure that we developed far the treatment of femoral pseudoaneurysms after catheterizati on. This study presents our current results of percutaneous ultrasound-guid ed thrombin injection for treating pseudoaneurysms that arise from various locations and causes. Methods: Between February 1996 and Map 1999, we performed thrombin injectio n of 83 pseudoaneurysms in 82 patients. There were 74 femoral pseudoaneurys ms: 60 from cardiac catheterization (36 interventional), seven from periphe ral arteriography (four interventional), five from intra-aortic balloon pum ps, and two from dialysis catheters. There were nine other pseudoaneurysms: five brachial (two cardiac catheterization, two gunshot wounds, one after removal of an infected arteriovenous graft), one subclavian (central venous catheter insertion), one radial (arterial line), and one distal superficia l femoral and one posterior tibial (both after blunt trauma). Twenty-nine p seudo aneurysms were injected while on therapeutic anticoagulation. Patient s underwent repeat ultrasound examination within 5 days and after 4 weeks. Results: Eighty-two of 83 pseudoaneurysms had initial successful treatment by this technique, including 28 of 29 in patients who were undergoing antic oagulation therapy. The only complication was thrombosis of a distal brachi al artery, which resolved spontaneously. There were early recurrences in se ven patients::four patients underwent successful reinjection; reinjection f ailed in two patients, who underwent surgical repair; and one patient had s pontaneous thrombosis on follow-up. After 4 weeks, ultrasound examinations were completely normal or showed some residual hematoma, and there were no recurrent pseudoaneurysms. Conclusion: Ultrasound-guided thrombin injection of pseudoaneurysms has exc ellent results, which support its widespread use as the primary treatment f or this common problem.