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(Radiology. 2000;215:403-408.)
© RSNA, 2000

Ultrasonography

Treatment of Iatrogenic Femoral Arterial Pseudoaneurysms: Comparison of US-guided Thrombin Injection with Compression Repair1

Erik K. Paulson, MD, Douglas H. Sheafor, MD, Mark A. Kliewer, MD, Rendon C. Nelson, MD, Lara B. Eisenberg, MD, Mark W. Sebastian, MD and Michael H. Sketch, Jr, MD

1 From the Departments of Radiology (E.K.P., D.H.S., M.A.K., R.C.N., L.B.E.), Surgery (M.W.S.), and Cardiology (M.H.S.), Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710. Received April 16, 1999; revision requested June 10; revision received July 8; accepted July 26. Address correspondence to E.K.P. (e-mail: pauls003@mc.duke.edu).

PURPOSE: To evaluate and compare the treatment of iatrogenic femoral arterial pseudoaneurysms by using ultrasonographically (US) guided direct thrombin injection with US-guided compression repair.

MATERIALS AND METHODS: Twenty-six patients with iatrogenic femoral arterial pseudoaneurysms were treated with direct thrombin injection. With US guidance, a 22-gauge needle was placed into the pseudoaneurysm flow lumen and thrombin (mean volume, 0.35 mL; range, 0.10–0.60 mL) was injected with continuous color Doppler US guidance. Demographics, clinical variables, pseudoaneurysm characteristics, and results in these patients were compared with those in 281 consecutive patients who underwent US-guided compression repair.

RESULTS: The success rate of thrombin injection was 96% (25 of 26 patients), which was significantly higher than that of compression, 74% (209 of 281 patients) (P = .013). Twenty of 26 (77%) patients required a single injection, and six (23%) required two injections. Mean thrombosis time for thrombin injection was 6 seconds, compared with 41.5 minutes for compression. For thrombin injection, there were no complications, foot pulses did not change and no patients required conscious sedation. Follow-up US at 24 hours showed no recurrent pseudoaneurysms.

CONCLUSION: For the treatment of iatrogenic femoral arterial pseudoaneurysms, thrombin injection with US guidance appears to be superior to compression repair.

Index terms: Aneurysm, femoral, 921.4124, 921.444, 922.4124, 922.444, 923.4124, 923.444 • Aneurysm, therapy, 921.1264, 921.12986, 922.1264, 922.12986, 923.1264, 923.12986 • Interventional procedures, comparative studies, 921.1264, 921.12986, 922.1264, 922.12986, 923.1264, 923.12986 • Interventional procedures, complications, 92.126, 92.444 • Ultrasound (US), guidance, 921.12986, 922.12986, 923.12986




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