Efficacy and Rationale of Endoscopic Ultrasound–Guided Thrombin Injection in Visceral Artery Pseudoaneurysm Not Amenable to Angioembolization

Abstract

Background Pseudoaneurysm usually occurs after vascular injuries or erosions such as in trauma or inflammation like pancreatitis and is associated with high morbidity and mortality. Aim The aim of study is to assess efficacy and safety of EUS-guided thrombin injection in pseudoaneurysm. Materials and Methods Prospective data collection was done at SMS Hospital, Jaipur, from January 2015 to March 2023. All patients with pseudoaneurysm were consecutively enrolled. Results Twenty patients (M/F, 18:2) with median age of 41 years (25–58 years), were studied. Underlying etiology of pseudoaneurysm was chronic pancreatitis in 75% of the patients, blunt trauma abdomen in 15% of the patients, recurrent acute pancreatitis in 5%, and idiopathic in 5% of the patients. At the time of admission, mean hemoglobin was 6.7 g/dL (3.4–8.2), with median blood transfusion requirement was 2 units (0–6 units). Hemoglobin values after 4–6 weeks showed a significant improvement (t = 9.21, P < 0.05). Mean dose of human thrombin required for complete obliteration of pseudoaneurysm was 520 ± 188.6 IU per patient (300–800 IU). Amount of thrombin (IU) dose needed to achieve complete obliteration correlated well significantly with the dimension of pseudoaneurysm, P value less than 0.05 (R = 0.80). Median follow-up duration in this study was 44 months (3–84 months), which was the longest follow-up period by far. Conclusions Endoscopic ultrasound–guided thrombin injection in visceral artery pseudoaneurysm is a safe and effective alternative for patients not amenable for digital subtraction angiography–guided angioembolization.