Femoral pseudoaneurysms:: Management with percutaneous thrombin injections -: Success rates and effects on systemic coagulation

PURPOSE: To determine the success rate of percutaneous ultrasonographically (US) guided thrombin injection in the treatment of femoral pseudoaneurysms; and to evaluate the effects of thrombin injection on systemic coagulation parameters. MATERIALS AND METHODS- Fifty femoral pseudoaneurysms (37 simple pseudoaneurysms with one lobe and 13 complex pseudoaneurysms with two or three lobes) were treated with US-guided percutaneous thrombin injections. Pseudoaneurysm size, neck length and Width, thrombin dose, outcome of therapy, and complications were documented prospectively. Duplex sonographic follow-up examinations were performed at 12-24 hours and 5-7 and 21-25 days. In 25 patients, activated thromboplastin time, Quick test (prothrombin time), thrombin time, fibrinogen, D-dimer, antithrombin III, thrombin-antithrombin Ill complex, and prothrombin fragments I and 2 were determined before and at 2, 5, and 10 minutes after thrombin injection, Differences in results before and those after thrombin injection were evaluated by means of the one-sample t test. RESULTS: Mean volume of pseudoaneurysms was 5.84 cm(3) +/- 4.89 (SD). Fifty-eight thrombin injections were performed. Mean thrombin dose was 357 IU +/- 291 in simple and 638 IU 549 in complex pseudoaneurysms. Primary success rate was 36 of 37 (97%) for simple and eight of 13 (61%) for complex pseudoaneurysms. Reperfusion occurred in four complex pseudoaneurysms (none in simple ones). Secondary success rate was 100%. No thromboembolic, infectious, or allergic complications occurred. During follow-up, reperfusion was detected in one patient with a complex pseudoaneurysm. Levels of thrombin-antithrombin Ill complex increased significantly (P < .05) after thrombin injection, whereas changes in all other laboratory tests were not significant. CONCLUSION: US-guided percutaneous injection of thrombin is successful and safe in the management of femoral pseudoaneurysms. The increase of thrombin-antithrombin [it complex indicates the possibility of thrombin passage into the arterial circulation.