10 YEARS OF EXPERIENCE IN ULTRASOUND-GUIDED THROMBIN INJECTION, A SAFE AND EFFECTIVE TECHNIQUE IN FEMORAL PSEUDOANEURYSM TREATMENT

  • Ricardo Correia Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHULC, Portugal
  • Danna Krupka NOVA Medical School, Universidade Nova de Lisboa, Portugal
  • Teresa Homem NOVA Medical School, Universidade Nova de Lisboa, Portugal
  • Rita Ferreira Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHULC, Portugal
  • Nelson Camacho Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHULC, Portugal
  • Joana Catarino Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHULC, Portugal
  • Rita Bento Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHULC, Portugal
  • Ana Garcia Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHULC, Portugal
  • Frederico Gonçalves Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHULC, Portugal
  • Maria Emília Ferreira Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, CHULC, Portugal
Keywords: Femoral pseudoaneurysm (PA), PA neck, Simple PA, Complex PA, Ultrasound-guided thrombin injection (UGTI), PA occlusion

Abstract

Introduction: Increased percutaneous vascular procedures lead to a growth in access-related complications, the most common of which is pseudoaneurysm (PA). Nowadays, femoral PA first-line treatment is ultrasound-guided thrombin injection (UGTI).

Methods: An observational retrospective study was designed. Patients who underwent UGTI on a tertiary hospital, from 2008 to 2018 were included. Data were collected from medical records. Primary endpoint was UGTI success (primary PA occlusion and after US revaluation PA occlusion). Secondary endpoints were procedure-related complications, reinterventions, hospitalization duration and survival.

Results: 102 patients were included. 97% of PA had a confirmed iatrogenic etiology. 4% were diagnosed after a vascular procedure and 85% after cardiology procedure, 80% of which after coronary catheterization and 13% after TAVI (transcatheter aortic valve implantation). 58% of patients where on antiplatelets and 50% on anticoagulation therapy. 80% of PA was located on the right groin. 65% affected CFA and 35% affected SFA or PFA. PA mean diameter was 36,8mm. 29% of PA were lobulated (complex PA). Regarding PA neck, 58% had long neck (length ≥3mm) and 58% had narrow neck (width <3mm). Median time from iatrogenic trauma to UGTI was 6 days. 89% of PA showed primary occlusion after UGTI; this rate decreased to 73% after US revaluation. 16% of patients repeated UGTI, 5% more than once. We identified no procedure-related complications. Complex PA were associated with lower rates of PA occlusion on US revaluation (p=0,012). We found no association between occlusion rates and affected artery, antithrombotic medication, PA diameter, neck length or width. 6% of patients underwent femoral PA surgical procedure (most of them after more than 2 UGTI); one underwent an endovascular repair procedure. After UGTI, hospitalization median time was 3 days, longer after TAVI compared with coronary catheterization (p=0,006). Patients mean survival was 97±2% at 1 month, 86±4% at 1 year e 60±7% at 5 years, with no significant difference between different PA etiologies.

Conclusion: UGTI is a safe and effective modality for PA treatment. We can expect that 1/6 of patients will need more than one UGTI to achieve expected success; this risk is higher in complex PA. Despite good results, some patients will continue to require surgical procedures.

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Published
2021-06-03
Section
Original Article

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