J Surg Ultrasound.  2022 May;9(1):13-17. 10.46268/jsu.2022.9.1.13.

Clinical Outcomes of Ultrasound-Guided Thrombin Injection for the Treatment of Iatrogenic Pseudoaneurysm

• Kim GW
• Rho YN
• Yun WS

• KMID: 2536059
• DOI: http://doi.org/10.46268/jsu.2022.9.1.13

Abstract

Purpose
The frequency of iatrogenic pseudoaneurysms is increasing with the growing popularity of endovascular treatment. This study examined the efficacy and safety of the ultrasound-guided thrombin injection for the treatment of iatrogenic pseudoaneurysm.
Methods
From January 2014 to January 2020, 20 patients underwent a USG-guided thrombin injection due to an iatrogenic pseudoaneurysm. Except for one patient without a USG image, 19 patients were enrolled in this study. The clinical data and USG images were reviewed retrospectively.
Results
The mean age of the patients was 69 years, and 31% were male. The site of the pseudoaneurysm consisted of the femoral artery (n = 16), arteriovenous fistula for hemodialysis access (n = 2), and radial artery (n = 1). The mean size of the pseudoaneurysm was 26 mm, and the mean length of the pseudoaneurysm neck was 6.8 mm. An immediate total occlusion of the pseudoaneurysm was achieved in 15 patients (79%). All four patients with a partial occlusion showed spontaneous total occlusion in the follow-up USG within three weeks. Regarding complications, there were one hematoma and one partial thrombosis of the adjacent native artery. Both were resolved with conservative treatment.
Conclusion
Ultrasound-guided thrombin injection is an effective and safe procedure for treating pseudoaneurysms.

Keyword

Aneurysm; False; Ultrasonography; Thrombin

Figure

• 

  Fig. 1 A 68-year-old female pre-sented with the right groin bulge after percutaneous coronary artery inter-vention. (A) A superficial femoral artery pseudoaneurysm was identified at the puncture site. After thrombin injection, pseudoaneurysm was com-pletely occluded with thrombus (B).

• 

  Fig. 2 68-year-old female with a pseudoaneurysm of the proximal superficial femoral artery on the color Doppler ultrasound (A). After thrombin injection, there was still non-thrombosed space around the pseudoaneurysm neck and to-and-fro waveform in the neck was detected (B). Follow-up ultrasound images after 2 days revealed total occlusion of pseudoaneurysm without superficial femoral artery occlusion (C).

• 

  Fig. 3 An 82-year-old female pre-sented with pulsating mass on the right wrist. Color Doppler and pulse wave Doppler ultrasound showed a radial artery pseudoaneurysm with a short neck (A). Although pseudo-aneurysm was completely thrombosed with thrombin injection, there was thrombus propagation (B, C). After 16 days, the thrombus in the radial artery disappeared on the follow-up ultrasound (D).

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