J Korean Soc Radiol.  2019 Sep;80(5):896-905. 10.3348/jksr.2019.80.5.896.

Percutaneous Thrombin Injection for the Treatment of Post-Procedural Iatrogenic Pseudoaneurysms

• Park S
• Shin JH
• Ko GY
• Gwon DI
• Ko HK
• Kim JW

• KMID: 2459015
• DOI: http://doi.org/10.3348/jksr.2019.80.5.896

Abstract

PURPOSE
To report our clinical experience of thrombin injection for iatrogenic pseudoaneurysms of peripheral arteries with or without balloon dilatation and coil embolization as adjunctive techniques.
MATERIALS AND METHODS
A total of 10 patients undergoing thrombin injection for iatrogenic pseudoaneurysms from September 2007 to June 2017 were retrospectively investigated. The causative procedures, location of pseudoaneurysms, and complications were recorded, and technical and clinical success rates of the treatment were assessed.
RESULTS
The femoral and brachial arteries were treated in eight and two patients, respectively. Technical success was confirmed in all cases, and a clinical success rate was 70% (7/10) was noted. Two patients presented with a complication of acute thrombosis at the distal arteries. In 7 patients, balloon occlusion was performed before injection of thrombin to prevent the spread of thrombin. Coil embolization of the distal branch was also performed in one of these patients.
CONCLUSION
For pseudoaneurysms of the femoral and brachial arteries that develop after various vascular procedures, thrombin injection is a safe and efficient treatment choice. In some cases, where there is concern for thrombin leakage, balloon occlusion and coil embolization could be performed together.

MeSH Terms

Aneurysm, False*
Arteries
Balloon Occlusion
Brachial Artery
Dilatation
Embolization, Therapeutic
Humans
Retrospective Studies
Thrombin*
Thrombosis
Thrombin

Figure

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  Fig. 1. A brachial artery pseudoaneurysm in a 45-year-old male patient (patient no. 6). A, B. Right brachial arteriograms show a pseudoaneurysm (arrows) with a relatively wide and short neck portion (arrowheads in A). C. With balloon dilatation at the neck portion, 4000 IU of thrombin was injected into the pseudoaneurysm under ultrasonography guidance (not shown). After thrombin injection, minimal residual nonthrombotic pseudoaneurysm (arrow) and filling defects (arrowheads) remained, suggesting acute thrombus along the right distal brachial artery and proximal radial artery. D. After immediate thrombectomy with a 5 Fr catheter (not shown), the brachial arteriogram shows residual pseudoaneurysm (arrows), but no residual thrombus.

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  Fig. 2. A deep femoral artery pseudoaneurysm in a 76-year-old female patient (patient no. 7). A. A right femoral arteriogram shows a saccular pseudoaneurysm (arrows) arising from the right deep femoral artery (arrowheads). B. To prevent distal migration of the thrombus, embolization of one muscular branch was performed with two microcoils (arrows). C. After balloon occlusion of the proximal deep femoral artery using a balloon catheter of 10-mm diameter, 3000 IU of thrombin was injected into the pseudoaneurysm under ultrasonography guidance. D. The arteriogram at completion shows complete exclusion of the pseudoaneurysm without immediate complications.

Reference

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