Percutaneous injection of thrombin for the treatment of pseudoaneurysms: the German multicentre registry.

AIMS

False aneurysms can be treated surgically or by ultrasound guided manual compression. Another method is to inject thrombin into the aneurysm under ultrasound guidance. We evaluated safety and efficacy of this approach in a multicentre registry.

METHODS AND RESULTS

In 595 consecutive patients a pseudoaneurysm (593 femoral arteries, 2 brachial arteries) was diagnosed 0 to 250 days (median 3 days) after a catheter procedure. The diameter of the aneurysm ranged from 0.5x0.5x0.5 (LxWxD) to 8x11x16 cm (median 2x2x1.6 cm). 20 U to 4000 U (median 400 U) of thrombin solution were injected into the aneurysm under ultrasound guidance.The procedure was technically successful in 587/595 (99%) patients.The aneurysms were thrombosed after the first injection in 531 (89%) patients. Thirty-eight (6%) patients needed a second injection and eight (1%) patients, a third injection because residual flow in the aneurysm was visible at follow-up. In four (0.7%) additional patients the thrombosis of the aneurysms was delayed and occurred only after 24 hours to seven days. Six (1%) patients surgery was performed after successful closure of the aneurysm to remove the resulting haematoma. The overall technical success rate was 99% and clinical success was achieved in 96%.Eight (1%) other patients underwent surgery due to thrombin injection failure.Complications occurred in nine patients (1,5%). Intravascular thrombus formation, deep venous thrombosis, pulmonary embolism due to deep venous thrombosis, transient paresthesia in the leg during injection.

CONCLUSIONS

Ultrasound guided thrombin injection is a safe, effective and rapid treatment of false aneurysms. Complications and recurrent pseudoaneurysms are rare.