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Percutaneous Ultrasound-Guided Thrombin Injection in Iatrogenic Arterial Pseudoaneurysms: Effectiveness and Complications |
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Young Hwan Koh, M.D. Hak Soo Kim, M.D.*, Hyung Sik Kim, M.D.*, Seung Kee Min, M.D.** |
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Department of Radiology, Boramae Hospital *Department of Radiology, Gachon Medical School **Department of General Surgery, Gachon Medical School |
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PURPOSE : To evaluate and describe the efficacy and side effects of a percutaneous thrombin injection under ultrasonography
guidance for the treatment of iatrogenic pseudoaneurysms
MATERIALS and METHODS : Eighteen consecutive iatrogenic pseudoaneurysm cases were treated with a thrombin injection.
The thrombin was injected into the pseudoaneurysm cavity using a 22-gauge needle under ultrasonographic
guidance. The causes of the pseudoaneurysms are as follows: post coronary angiography (9 cases), percutaneous
coronary balloon angioplasty (5 cases), cerebral angiography (1 case), transhepatic chemoembolization
(1 case), percutaneous transfemoral arterial stent insertion (1 case) and bone marrow aspiration for a marrow
transplant (1 case).
RESULTS : Only one case required a secondary thrombin injection due to recurrent flow in the pseudoaneurysm lumen,
which was detected at the follow up Doppler ultrasound. Other seventeen cases were successfully treated
on the first trial. There were no technical failures or complication related to the procedure. The average amount
of thrombin injected was 733 IU. Nine out of 18 treated patients (50%) showed mild reactions to the thrombin
including mild fever (4 cases), chilling sensation (3 cases), a chilling sensation with mild dyspnea (1 case), mild
chest discomfort (1 case) after the thrombin injection. All these side effects were transient and improved several
hours later.
CONCLUSION : All the iatrogenic pseudoaneurysms were treated successfully with an ultrasound-guided percutaneous
thrombin injection. There was a high rate of hypersensitivity to the bovine thrombin, which precaution
should be taken to prevent more serious side effects. |
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Keyword : Aneurysm, femoral Aneurysm, therapy Ultrasound (US), guidance |
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pdf파일 : 145-150고영환.pdf
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