This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ghersin, E. Articles by Engel, A. Search for Related Content PubMed PubMed Citation Articles by Ghersin, E. Articles by Engel, A.

Percutaneous Ultrasonographically Guided Thrombin Injection of Iatrogenic Pseudoaneurysms in Unusual Sites

Departments of Diagnostic Imaging (E.G., D.G., A.O., A.E.) and Vascular Surgery (T.K., S.N., H.S., A.H.), Rambam Medical Center, Haifa, Israel.

Address correspondence and reprint requests to Eduard Ghersin, MD, Department of Diagnostic Radiology, Rambam Medical Center, PO Box 9602, Haifa 31096, Israel. E-mail: ghersine{at}hotmail.com.

Objectives. To evaluate the effectiveness and safety of percutaneous ultrasonographically guided thrombin injection as treatment of unusually positioned and unusually large iatrogenic pseudoaneurysms. Methods. Five patients with iatrogenic pseudoaneurysms were evaluated by color duplex ultrasonography. Two patients had additional digital angiography, and 2 had additional computed tomographic angiography. In 3 of the patients, large, painful iatrogenic pseudoaneurysms located proximal (2 patients) and distal (1 patient) to the arteriovenous hemodialysis fistulas had developed, most likely due to erroneous puncture of the arterial side (brachial artery) or venous side (cephalic vein) of the fistulas. An iatrogenic pseudoaneurysm of the anterior tibial artery had developed in the fourth patient after osteotomy of the fibula, and an iatrogenic pseudoaneurysm of the superficial femoral artery had developed in the fifth patient after erroneous puncture during venous transfemoral angiography. With a sterile technique and color duplex ultrasonographic guidance, a diluted solution of bovine thrombin was slowly injected directly into the iatrogenic pseudoaneurysms until cessation of blood flow was seen. Follow-up color duplex ultrasonography was performed 24 to 48 hours after the ultrasonographically guided thrombin injection. Results. Four iatrogenic pseudoaneurysms were successfully thrombosed during 1 session. Two large iatrogenic pseudoaneurysms necessitated multiple repositions of the injecting needle and several injections of small amounts of thrombin into the residual patent lumen to induce complete thrombosis without an appreciable increase in the total thrombin dosage. Follow-up examinations revealed complete and persistent thrombosis without evidence of distal embolization. One iatrogenic pseudoaneurysm involving the cephalic vein, distal to an arteriovenous hemodialysis fistula, recurred after apparently successful initial thrombosis. Conclusions. Most iatrogenic pseudoaneurysms are amenable to ultrasonographically guided thrombin injection as long as they are imaged adequately by color duplex ultrasonography.

Key Words: arteriovenous hemodialysis fistula • computed tomographic angiography • percutaneous thrombin injection • pseudoaneurysm • ultrasonography

Abbreviations: AHF, arteriovenous hemodialysis fistula • CDU, color duplex ultrasonography • CTA, computed tomographic angiography • IP, iatrogenic pseudoaneurysm • PUGTI, percutaneous ultrasonographically guided thrombin injection • SFA, superficial femoral artery

This article has been cited by other articles:

				L. R. Leon Jr and K. R. Goshima Delayed Superficial Femoral Artery Stent Erosion and Pseudoaneurysm Following Endovascular Therapy for Occlusive Disease Vascular and Endovascular Surgery, October 1, 2009; 43(5): 502 - 508. [Abstract] [PDF]

				M. Luedde, U. Krumsdorf, J. Zehelein, B. Ivandic, T. Dengler, H. A. Katus, and C. Tiefenbacher Treatment of Iatrogenic Femoral Pseudoaneurysm by Ultrasound-Guided Compression Therapy and Thrombin Injection Angiology, September 1, 2007; 58(4): 435 - 439. [Abstract] [PDF]

				M. A. Pozniak, C. Mitchell, and M. Ledwidge Radial Artery Pseudoaneurysm: A Maneuver to Decrease the Risk of Thrombin Therapy J. Ultrasound Med., January 1, 2005; 24(1): 119 - 122. [Full Text] [PDF]