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  • Title: Ultrasound-guided thrombin injection of femoral artery pseudoaneurysms.
    Author: Etemad-Rezai R, Peck DJ.
    Journal: Can Assoc Radiol J; 2003 Apr; 54(2):118-20. PubMed ID: 12736923.
    Abstract:
    OBJECTIVE: To evaluate whether the positive initial results for ultrasound-guided percutaneous thrombin injection of pseudoaneurysms, reported predominantly in small retrospective series, would be supported in a larger prospective trial. METHODS: In April 1999, our institution adopted ultrasound-guided thrombin injection as the initial treatment for post-catheterization arterial pseudoaneurysm. Colour Doppler imaging delineates the pseudoaneurysm, its neck and the adjacent artery. A 22-gauge spinal needle is attached to a 1-mL syringe preloaded with thrombin at a concentration of 1000 U/mL. Under ultrasound guidance, the needle tip is positioned within the pseudoaneurysm, and real-time colour Doppler imaging is used to monitor the pseudoaneurysm as thrombin is slowly injected. Thrombus formation commences almost immediately, and in most cases, occlusion is complete within 5 seconds. RESULTS: We successfully treated 61 pseudoaneurysms in 61 consecutive patients. The amount of thrombin injected ranged from 20 U to 3000 U (mean 435 U); 55 pseudoaneurysms were successfully treated after a single injection, and 6 patients required a repeat injection for complete occlusion. One patient had 2 pseudoaneurysms treated on consecutive days, and 1 developed a symptomatic vasovagal reaction, which was treated conservatively. No other significant procedural complications were encountered. Fifty-nine patients had a follow-up groin Doppler sonogram between 1 and 5 days after treatment. CONCLUSION: Ultrasound-guided percutaneous thrombin injection is an effective, simple, fast and safe treatment for post-catheterization arterial pseudoaneurysm. It has replaced ultrasound-guided compression repair at our institution and is now our treatment of choice.
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