Journal List > J Korean Soc Radiol > v.80(5) > 1134528

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Park, Shin, Ko, Gwon, Ko, and Kim: Percutaneous Thrombin of Post-Procedural Iatrogenic Injection for the Treatment Pseudoaneurysms
Original Article

J Korean Soc Radiol 2019;80(5):896-905.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.5.896

Percutaneous Thrombin of Post-Procedural Iatrogenic Injection for the Treatment Pseudoaneurysms

Sohee Park, MD, Ji Hoon Shin, MD∗, Gi-Young Ko, MD, Dong Il Gwon, MD, Heung Kyu Ko, MD, Jong Woo Kim, MD

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

∗Corresponding author Ji Hoon Shin, MD Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel 82-2-3010-4380 Fax 82-2-476-0090 E-mail jhshin@amc.seoul.kr

Received 11 October 2018       Revised 23 December 2018       Accepted 17 March 2019

Copyright © 2019 The Korean Society of Radiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report our clinical experience of thrombin injection for iatrogenic pseudoaneu-rysms of peripheral arteries with or without balloon dilatation and coil embolization as adjunctive techniques.

Materials and Methods

A total of 10 patients undergoing thrombin injection for iatrogenic pseudoaneurysms from September 2007 to June 2017 were retrospectively investigated. The causative procedures, location of pseudoaneurysms, and complications were recorded, and technical and clinical success rates of the treatment were assessed.

Results

The femoral and brachial arteries were treated in eight and two patients, respectively. Technical success was confirmed in all cases, and a clinical success rate was 70% (7/10) was noted. Two patients presented with a complication of acute thrombosis at the distal arteries. In 7 patients, balloon occlusion was performed before injection of thrombin to prevent the spread of thrombin. Coil embolization of the distal branch was also performed in one of these patients.

Conclusion

For pseudoaneurysms of the femoral and brachial arteries that develop after various vascular procedures, thrombin injection is a safe and efficient treatment choice. In some cases, where there is concern for thrombin leakage, balloon occlusion and coil embolizationcould be performed together.

References

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Fig. 1.
A brachial artery pseudoaneurysm in a 45-year-old male patient (patient no. 6). A, B. Right brachial arteriograms show a pseudoaneurysm (arrows) with a relatively wide and short neck portion (arrowheads in A). C. With balloon dilatation at the neck portion, 4000 IU of thrombin was injected into the pseudoaneurysm under ultrasonography guidance (not shown). After thrombin injection, minimal residual nonthrombotic pseudoaneurysm (arrow) and filling defects (arrowheads) remained, suggesting acute thrombus along the right distal brachial artery and proximal radial artery. D. After immediate thrombectomy with a 5 Fr catheter (not shown), the brachial arteriogram shows residual pseudoaneurysm (arrows), but no residual thrombus.
jksr-80-896f1.tif
Fig. 2.
A deep femoral artery pseudoaneurysm in a 76-year-old female patient (patient no. 7). A. A right femoral arteriogram shows a saccular pseudoaneurysm (arrows) arising from the right deep femoral artery (arrowheads). B. To prevent distal migration of the thrombus, embolization of one muscular branch was performed with two microcoils (arrows). C. After balloon occlusion of the proximal deep femoral artery using a balloon catheter of 10-mm diameter, 3000 IU of thrombin was injected into the pseudoaneurysm under ultrasonography guidance. D. The arteriogram at completion shows complete exclusion of the pseudoaneurysm without immediate complications.
jksr-80-896f2.tif
Table 1.
Pseudoaneurysms Treated with Thrombin Injection in 10 Patients
No. Age (years)/Sex Cause Location Thrombin Dose (U) Adjunctive Technique Outcome Complications
1 80/M Aortic stent graft Lt. CFA 2000 Balloon Technical success, treatment success -
2 84/F CAG + PTCA Rt. DFA 5000 Balloon Technical success, treatment success -
3 66/M ECMO Lt. SFA 5000 Balloon Technical success, residual Acute thrombosis
            pseudoaneurysm on CT after 5 day → balloon remodeling
4 69/F PTCA Rt. CFA 3000 - pseudoaneurysm on CT after 5 day Technical success, treatment success → balloon remodeling −
5 66/M IMA embolization Rt. CFA 800 - Technical success, treatment success -
6 45/M ABGA Rt. brachial 4000 Balloon Technical success, residual Acute thrombosis
      artery     pseudoaneurysm on US after 1 day → thrombectomy
7 76/F CAG Rt. DFA 3000 Balloon, coil Technical success, treatment success -
8 65/F ICA angioplasty Rt. SFA 4000   Technical success, treatment success -
9 33/F Hemodialysis Rt. brachial 5000 Balloon Technical success, residual -
      aretery     pseudoaneurysm on US after 1 day  
10 86/F EVAR with Rt. CFA 1000 Balloon Technical success, treatment success -
    IIA embolization          

ABGA = arterial blood gas analysis, CAG = coronary angiography, CFA = common femoral artery, CT = computed tomography, DFA = deep femoral artery, ECMO = extracorporeal membrane oxygenation, EVAR = endovascular aneurysm repair, ICA = internal carotid artery, IIA = interna iliac artery, IMA = inferior mesenteric artery, PTCA = percutaneous transluminal coronary angioplasty, SFA = superficial femoral artery, US = ultrasonography

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