Safety evaluation of percutaneous ultrasound-guided thrombin injection into pseudoaneurysms

Abstract

Summary Introduction: common application of endovascular procedures is frequently connected with increasing risk of pseudoaneurysm at the site of the artery puncture. The most frequent method of treatment of aneurysms is percutaneus ultrasound-guided thrombin injection. The aim of this research was safety evaluation of treatment of pseudoaneurysm by thrombin injection based on own experience . Methods and materials: 70 people (53% women, 43% men, average age 67.9 ±10.5) with pseudoaneurysm and under ultrasound-guided thrombin injection treatment carried out between 2007 and 2018 in the Department of General and Vascular Surgery of Pirogow Hospital in Lodz were analysed. Patients were qualified to treatment based on aneurysm and channel morphology in ultrasound examination. Before application of medicine blood supply to the limb was clinically assessed and examined using sonography. The tip of the needle was imaged into the lumen of the aneurysm. Results: in the research group, average aneurysm diameter was 29.9mm (± 17.2) within a range from 10mm to 96mm. Multi-chamber aneurysm was detected in 21% of patients. Mean channel length was 12mm (±7.7), mean width 3.5mm (±1.4), mean thrombin injected 1.7ml (±0.7) within range from 0.5 to 4ml. The treatment was successful in 94% of cases. Complications after thrombin injection occurred in 7% of cases (1 patient suffered from shock, 1 from thrombus in the saphenous vein, 3 from thrombus moving from aneurysm neck to femoral artery). No deterioration of blood supply in a limb was detected after obliteration of aneurysm. No relevant differences in aneurysm and channel dimensions were detected between groups with and without complications (p > 0.05). Conclusions: obliteration of the pseudoaneurysm by percutaneous ultrasound-guided thrombin injection is a highly effective method. This method is considered as safe, however, it requires experience. Its application may cause complications of which some are clinically significant and may lead to health and life threatening situations. In some specific cases surgical treatment of choice should be considered.