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Therapeutic thrombin injection of pseudoaneurysms: a multicenter experience

Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA, mohlere{at}uphs.upenn.edu

Marc E Mitchell

Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Jeffrey P Carpenter

Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

D Eugene Strandness, Jr

Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA

Michael R Jaff

The Heart and Vascular Institute, Morristown, NJ, USA

Joshua A Beckman

Department of Medicine, Harvard Medical School, Boston, MA, USA

Marie Gerhard-Herman

Department of Medicine, Harvard Medical School, Boston, MA, USA

The standard non-invasive treatment of pseudoaneurysms has been ultrasound-guided compression (UGC). Problems with UGC include pain at the site of compression, long compression times and incomplete closure. Each of these difficulties is exacerbated with large pseudoaneurysms. Recently, ultrasound-guided injection of pseudoaneurysms with thrombin has gained popularity. The goal of this study was to report a multicenter registry using this technique and in so doing detail the clinical utility and safety of this emerging procedure. The medical records of all patients diagnosed with pseudoaneurysm in the vascular laboratory who underwent thrombin injection over the past year were reviewed for patient characteristics and clinical outcome. There were 91 patients (55 male) with a mean age of 69 years. Three patients also had an arteriovenous fistula. The majority of patients were receiving one or more antiplatelet agents and/or anticoagulants. All patients underwent pseudoaneurysm injection with bovine thrombin. The mean aneurysm diameter was 3.3 cm, with a range of 1.5-6.3 cm. Successful thrombosis of the pseudoaneurysm was achieved in 89/91 (98%) of cases. Anticoagulation with heparin was used in one of the unsuccessful cases. In two cases, UGC was used to close a small active region that did not completely thrombose after thrombin injection. There were two patients who had recurrence of pseudoaneurysm the day after successful injection and thrombosis of the pseudoaneurysm. There were no local complications after injection; however, one patient suffered a pulmonary embolus that was thought to be unrelated to the procedure. In conclusion, thrombin injection for the treatment of pseudoaneurysms is safe and effective, even in patients receiving anticoagulation. This procedure should be considered as the initial therapeutic approach for peripheral pseudoaneurysms.

Key Words: catheterization • pseudoaneurysm • thrombin • ultrasound

Vascular Medicine, Vol. 6, No. 4, 241-244 (2001)
DOI: 10.1177/1358836X0100600407


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