Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms

Background-This prospective study was designed to assess the safety and eff icacy of using bovine thrombin injection to treat pseudoaneurysms. Methods and Results-From April 1998 through December 1999, 70 pseudoaneurys m were injected with bovine thrombin under the guidance of color duplex ult rasound. The most superficial pseudoaneurysm chamber was entered with a 1.5 -inch, 19- to 22-gauge or spinal needle. Bovine thrombin, in a 1000 U/cc so lution, was injected into the chamber. A total of 36 women and 34 men under went ultrasound-guided thrombin injection (UGTI). Their mean age was 69.5 y ears. Most pseudoaneurysms were associated with diagnostic cardiac catheter ization or percutaneous coronary intervention (80%). Two pseudoaneurysms ar ose from the brachial artery; the remainder were in the groin. Twenty-one p atients were being treated with either heparin or warfarin, and the majorit y of the others were on antiplatelet therapy with aspirin or clopidogrel. U GTI was successful in 66 of the 70 patients (94%). The first patient in the series had 2 attempts at thrombin injection and refused further attempts. Two patients had undergone stent graft placement and had short, wide tracts . Both of these patients required surgical repair of their pseudoaneurysms. The fourth patient had a nearly complete pseudoaneurysm thrombosis and was lost to follow-up on discharge. No arterial thrombotic events occurred. On e patient had a soleal vein thrombosis in the ipsilateral leg. Conclusions-UGTI was safe and effective in 94% of patients with postcathete rization pseudoaneurysms, Anticoagulant use did not hinder successful throm bosis. UGTI should be the initial treatment of choice for patients with pos tcatheterization pseudoaneurysms.