Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms

A prospective analysis

W. R. Sackett, S. M. Taylor, C. B. Coffey, K. D. Viers, E. M. Langan, D. L. Cull, B. A. Snyder, T. M. Sullivan, E. E. Rigdon, C. S. Kiell, J. B. Cofer, V. P. Rao, J. D. Richardson, S. L. Minken, W. Cornett

Research output: Contribution to journalArticle

Abstract

An adverse consequence of the use of the femoral artery for the endovascular evaluation and treatment of arterial disease is the increased incidence of iatrogenic femoral pseudoaneurysms. Although surgical repair has traditionally been used to treat such aneurysms, less invasive modalities have emerged. The purpose of this study is to prospectively evaluate ultrasound-guided thrombin injection (UGTI) for the treatment of iatrogenic femoral pseudoaneurysms. A treatment protocol was approved and 30 stable patients (21 female; age range 43-85 years; mean 67 years) were prospectively enrolled from December 1997 through June 1999 to undergo UGTI on 30 iatrogenic femoral pseudoaneurysms. Pseudoaneurysms occurred after cardiac intervention (n = 22, 73%), peripheral intervention (n = 7, 23%), and after a femoral line placement (n = 1, 3%). They ranged in size from one to 5 cm with a time interval from intervention until UGTI of one to 132 days (median 3 days). Eleven patients (37%) were systematically anticoagulated at the time of UGTI. All pseudoaneurysms were treated using sterile technique and local anesthesia with ultrasound-guided injection via a 20-gauge spinal needle of 0.1 to 2 cm3 (median 0.6 cm3) of 1000 units/cm3 topical thrombin solution administered by one of six physicians. A period of bedrest for 4 to 6 hours after injection was followed by repeat groin duplex scan at 24 hours and a clinical follow-up at 30 days. There were no procedural deaths or nonvascular complications. Twenty-seven (90%) UGTIs resulted in successful pseudoaneurysm ablation with no recurrences at 24 hours or 30 days. Two (7%) UGTIs failed and one (3%) femoral artery embolic complication occurred; all were successfully treated with surgery. Success appeared to be independent of anticoagulation status, pseudoaneurysm age, size, or operator experience. We conclude that UGTI is a safe, easy, well-tolerated and effective noninvasive method for treatment of iatrogenic femoral pseudoaneurysms and should be considered in all stable patients before operative repair.

Original languageEnglish (US)
Pages (from-to)937-942
Number of pages6
JournalAmerican Surgeon
Volume66
Issue number10
StatePublished - 2000
Externally publishedYes

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False Aneurysm
Thigh
Thrombin
Injections
Femoral Artery
Bed Rest
Groin
Local Anesthesia
Clinical Protocols
Needles
Aneurysm
Therapeutics
Physicians
Recurrence
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Sackett, W. R., Taylor, S. M., Coffey, C. B., Viers, K. D., Langan, E. M., Cull, D. L., ... Cornett, W. (2000). Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms: A prospective analysis. American Surgeon, 66(10), 937-942.

Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms : A prospective analysis. / Sackett, W. R.; Taylor, S. M.; Coffey, C. B.; Viers, K. D.; Langan, E. M.; Cull, D. L.; Snyder, B. A.; Sullivan, T. M.; Rigdon, E. E.; Kiell, C. S.; Cofer, J. B.; Rao, V. P.; Richardson, J. D.; Minken, S. L.; Cornett, W.

In: American Surgeon, Vol. 66, No. 10, 2000, p. 937-942.

Research output: Contribution to journalArticle

Sackett, WR, Taylor, SM, Coffey, CB, Viers, KD, Langan, EM, Cull, DL, Snyder, BA, Sullivan, TM, Rigdon, EE, Kiell, CS, Cofer, JB, Rao, VP, Richardson, JD, Minken, SL & Cornett, W 2000, 'Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms: A prospective analysis', American Surgeon, vol. 66, no. 10, pp. 937-942.
Sackett WR, Taylor SM, Coffey CB, Viers KD, Langan EM, Cull DL et al. Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms: A prospective analysis. American Surgeon. 2000;66(10):937-942.
Sackett, W. R. ; Taylor, S. M. ; Coffey, C. B. ; Viers, K. D. ; Langan, E. M. ; Cull, D. L. ; Snyder, B. A. ; Sullivan, T. M. ; Rigdon, E. E. ; Kiell, C. S. ; Cofer, J. B. ; Rao, V. P. ; Richardson, J. D. ; Minken, S. L. ; Cornett, W. / Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms : A prospective analysis. In: American Surgeon. 2000 ; Vol. 66, No. 10. pp. 937-942.
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abstract = "An adverse consequence of the use of the femoral artery for the endovascular evaluation and treatment of arterial disease is the increased incidence of iatrogenic femoral pseudoaneurysms. Although surgical repair has traditionally been used to treat such aneurysms, less invasive modalities have emerged. The purpose of this study is to prospectively evaluate ultrasound-guided thrombin injection (UGTI) for the treatment of iatrogenic femoral pseudoaneurysms. A treatment protocol was approved and 30 stable patients (21 female; age range 43-85 years; mean 67 years) were prospectively enrolled from December 1997 through June 1999 to undergo UGTI on 30 iatrogenic femoral pseudoaneurysms. Pseudoaneurysms occurred after cardiac intervention (n = 22, 73{\%}), peripheral intervention (n = 7, 23{\%}), and after a femoral line placement (n = 1, 3{\%}). They ranged in size from one to 5 cm with a time interval from intervention until UGTI of one to 132 days (median 3 days). Eleven patients (37{\%}) were systematically anticoagulated at the time of UGTI. All pseudoaneurysms were treated using sterile technique and local anesthesia with ultrasound-guided injection via a 20-gauge spinal needle of 0.1 to 2 cm3 (median 0.6 cm3) of 1000 units/cm3 topical thrombin solution administered by one of six physicians. A period of bedrest for 4 to 6 hours after injection was followed by repeat groin duplex scan at 24 hours and a clinical follow-up at 30 days. There were no procedural deaths or nonvascular complications. Twenty-seven (90{\%}) UGTIs resulted in successful pseudoaneurysm ablation with no recurrences at 24 hours or 30 days. Two (7{\%}) UGTIs failed and one (3{\%}) femoral artery embolic complication occurred; all were successfully treated with surgery. Success appeared to be independent of anticoagulation status, pseudoaneurysm age, size, or operator experience. We conclude that UGTI is a safe, easy, well-tolerated and effective noninvasive method for treatment of iatrogenic femoral pseudoaneurysms and should be considered in all stable patients before operative repair.",
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AU - Sackett, W. R.

AU - Taylor, S. M.

AU - Coffey, C. B.

AU - Viers, K. D.

AU - Langan, E. M.

AU - Cull, D. L.

AU - Snyder, B. A.

AU - Sullivan, T. M.

AU - Rigdon, E. E.

AU - Kiell, C. S.

AU - Cofer, J. B.

AU - Rao, V. P.

AU - Richardson, J. D.

AU - Minken, S. L.

AU - Cornett, W.

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