Percutaneous injection of thrombin for the treatment of pseudoaneurysms after catheterization: An alternative to sonographically guided compression

OBJECTIVE. The purpose of our study was to determine the efficacy of percut aneous thrombin treatment fur iatrogenic pseudoaneurysms of the femoral art ery in comparison with sonographically guided compression repair. SUBJECTS AND METHODS. Twenty-three pseudoaneurysms occurring after catheter ization were treated percutaneously with an initial injection of 1.0 mL of thrombin solution via a 22-gauge spinal needle under continuous sonographic guidance. Four patients required the additional injection of 1.0-4.0 mL of thrombin for complete thrombosis. Repeated sonography was performed 24 hr after injection. Additionally, we compared our results with those of a cont rol group by reviewing the imaging findings and medical records of 16 patie nts who underwent sonographically guided compression of iatrogenic pseudoan eurysms between January 1998 and July 1998. RESULTS. Twenty-two of 23 pseudoaneurysms ocurring after catheterization we re successfully treated with percutaneous thrombin injection. One recurrenc e was identified 2il hr after injection in a patient who experienced a sign ificant complication. Procedure lime was limited to 15 min with an overall success rate of 96%. Retrospectively, 18 iatrogenic pseudoaneurysms were id entified in 16 patients. Six (60%) of 10 pseudoaneurysms were successfully compressed under sonographic guidance, with an average time to thrombosis o f 32 min. Compression was unsuccessful for four pseudoaneurysms with an ave rage compression time of 45 min. Compression could not be performed in seve n patients (39%). The overall success rate of sonographically guided repair was 60%. CONCLUSION. Preliminary evidence suggests that sonographically guided percu taneous thrombin injection is a safe and effective method of treatment for iatrogenic pseudoaneurysms and offers significant advantages over conventio nal sonographically guided compression.