Abstract 6056: The Recurrence of Iatrogenic Femoral Artery Pseudoaneurysm after Occlusion by Ultrasound Guided Percutaneous Thrombin Injection
Aim: To evaluate efficacy of ultrasound guided percutaneous thrombin injection of iatrogenic femoral artery pseudoaneurysm and to assess the risk factors associated with recurrence of pseudoaneurysm after thrombin application.
Methods: We treated 210 patients (pts, male/female: 79/131) aged 76 years (range 62–83) presented with femoral artery pseudoaneurysm after cardiac catheterization by percutaneous ultrasound guided thrombin injection (500 IU/ml solution of activated human thrombin). The mean pseudoaneurysm diameter was 2.1×1.3cm. Very small cavities (less then 1.5×1.5cm) suitable for local compressive therapy, and very big cavities (5×5cm) scheduled for surgery, were excluded from the study. The factors associated with recurrence of pseudoaneurysm were retrospectively analyzed.
Results: One hundred eighty-three pts were successfully treated by one injection of activated thrombin (average amount 0.4±0.2ml, immediate success rate 87% 183/210). In 25 pts (12%), immediate short local compression (2 min) following injection was needed for complete occlusion. Overall success rate was 99% (208/210). In one case, progression of pseudoaneurysm required conversion to surgical repair (0.5%). In one patient with preexisting significant stenosis of superficial femoral artery acute limb ischemia developed after thrombin application and was treated by local thrombolysis (0.5%). During the 30-days follow-up recurrence of pseudoan-eurysm occurred in 11 pts (5%), exclusively the second and the third day after the first injection. All of them were successfully treated by the second thrombin application. The recurrence of pseudoaneurysm was associated with obesity (BMI>30, r=0.42, 95% CI 0.26 – 0.56, p<0.0001), and with extensive combination of antiagregation and anticoagulation therapy (ASA, thienopyridins, LMWH), (r=0.64, 95% CI 0.53–0.73, p<0.0001).
Conclusion: Ultrasound-guided thrombin injection is a safe and effective treatment of iatrogenic femoral artery pseudoaneurysm. It should be considered as a method of choice in suitable patients. Low rates of recurrence are associated with obesity and extensive use of combined antiagregation and anticoagulation therapy.