Selective use of Duplex Ultrasound after Successful Thrombin Injection of Pseudoaneurysms

Abstract

Introduction Duplex-guided thrombin injection (DGTI) has been shown to be a safe and efficacious initial treatment of iatrogenic arterial pseudoaneurysms. Postinjection follow-up duplex ultrasound examination has become the accepted standard of care despite 1) the use of intraprocedural ultrasonography to monitor successful thrombosis, 2) a low post-DGTI recurrence rate, and 3) the relatively high cost of ultrasonography. A retrospective study of DGTI at our institution was conducted to examine the necessity of routine duplex ultrasound after successful DGTI, along with a review of the relevant literature. Patient Population/Methods A retrospective review was conducted of 82 patients with iatrogenic arterial pseudoaneurysms (12 complex; 25.6%) treated with DGTI after initial diagnostic duplex ultrasonography. Immediate routine follow-up duplex ultrasound was performed on 71 of 82 cases (86.6%), whereas 11 patients received only clinical follow-up at the surgeon's discretion. Patient demographics, pseudoaneurysm anatomy, procedural details, outcomes, and complications were retrospectively documented and analyzed. Results From January 2002 to November 2003, 82 patients (59.8% women) underwent DGTI for pseudoaneurysm, with the majority located in the common femoral artery (48 of 82; 58.5%). Eighty pseudoaneurysms (97.6%) were treated with DGTI, with 78 (95.1%) being initially successful. Four of 78 (5%) follow-up examinations were judged to be of clinical significance: 2 of 78 patients (2.6%) became symptomatic and experienced pseudoaneurysm recurrence, whereas 2 of 78 patients were found to have an additional, previously undocumented, pseudoaneurysm. Three of these four resolved with a second injection, whereas one resolved without additional treatment. No thromboembolic, allergic, or infectious complications related to DGTI occurred. Conclusions In concert with the available literature, this cohort confirms that DGTI is a safe and effective treatment of iatrogenic arterial pseudoaneurysms with a low rate of recurrence, complication, and need for conversion to surgical intervention. DGTI should undoubtedly be the initial treatment of choice for pseudoaneurysms; however, follow-up duplex ultrasonography can be reserved for the clinically symptomatic patient.