Ann Surg Treat Res.  2020 May;98(5):270-276. 10.4174/astr.2020.98.5.270.

Ultrasound-guided thrombin injection for treatment of iatrogenic femoral artery pseudoaneurysms compared with open surgery: first experiences from a single institution

• Saydam O
• Serefli D
• Engin AY
• Atay M

• KMID: 2500828
• DOI: http://doi.org/10.4174/astr.2020.98.5.270

Abstract

Purpose
The frequency of iatrogenic femoral artery pseudoaneurysm (FAP) diagnoses has recently increased due to the growing use of diagnostic and interventional procedures involving large diameter sheaths, as well as more potent anticoagulation procedures. In this study, we aimed to present our experience with ultrasound-guided thrombin injection (UGTI) in patients with iatrogenic FAP.
Methods
We studied patients with FAP who were under anticoagulant or antiplatelet therapies preoperatively, or who had received a loading dose during an interventional procedure. The outcomes of patients with FAP treated with UGTI were compared with those of patients who underwent open surgical repair for pseudoaneurysms.
Results
Among the 55 patients included in this study, 24 had UGTI while 31 had open surgery. The success rate was 95.8% when taking into consideration primary and secondary attempts. The mean duration of the procedure was shorter in patients with UGTI (10.1 ± 3.54 minutes) when compared with those who underwent open surgery (76.55 ± 26.74 minutes, P ≤ 0.001). In addition, the total complication frequency was significantly higher in the open surgery group (P = 0.005), as was their length of hospital stay (P < 0.001). Cost analysis showed significant differences between UGTI ($227.50 ± $82.90) and open surgery ($471.20 ± $437.60, P = 0.01).
Conclusion
We have found that UGTI is the safer and more effective choice of treatment in appropriate patients with FAP, as opposed to surgery.

Keyword

False aneurysm; Femoral artery; Interventional ultrasonography; Thrombin; Vascular surgical procedures

Figure

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  Fig. 1 Flow diagram of the treatment protocol for iatrogenic femoral artery pseudoaneurysms. FAP, femoral artery pseudoaneurysm; UGTI, ultrasound-guided thrombin injection.

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