Clinical application of ultrasound-guided thrombin injection in treatment of iatrogenic femoral artery pseudoaneurysm_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MA Jinman ¹ , WANG Tiehao ¹ , WU Zhoupeng ¹ , LIU Chuncheng ² ,  WEN Xiaorong ² ,  YUAN Ding ¹ , MA Yukui ¹ , ZHAO Jichun ¹

1. Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Ultrasound Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WEN Xiaorong, Email: hxwenxiaor@126.com; YUAN Ding, Email: docyuanding@gmail.com

Keywords：

iatrogenic femoral artery pseudoaneurysm; ultrasound; thrombin injection; femoral artery

DOI：

10.7507/1007-9424.202102028

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Objective To explore the ultrasonic morphological indexes influencing the effectiveness of ultrasound-guided thrombin injection (UGTI) in the treatment of iatrogenic femoral artey pseudoaneury (IFAP).Methods The patients with IFAP treated by UGTI in the West China Hospital of Sichuan University from 2015 to 2017 were collected according to the inclusion criteria. The demographic data, comorbidities, clinical symptoms, ultrasonic morphological parameters, thrombin dosage, and postoperative complications were analyzed. The risk factors of technical success of UGTI were analyzed by logistic regression analysis. The technical success was defined as absence of flow within the FAP immediately after UGTI. Results A total of 53 patients who met the criteria of inclusion were included in this study. The technical and treatment success rates of UGTI were 84.9% (45/53) and 96.2% (51/53), respectively. No deep venous thrombosis, arterial thromboembolism, infection, bleeding, allergy, and other complications or death occurred in all patients. There were no statistical differences in the age, clinical symptoms, comorbidities (except hypertension, P=0.040), ultrasonic morphological parameters (except femoral artery diameter, P<0.001), and thrombin dosage between the patients with technical success and failure (P>0.05). Multivariate logistic regression analysis showed that the smaller femoral artery diameter was the risk factor of the technical failure [OR=0.350, 95%CI (0.165, 0.743), P=0.006]. Further adjustment of thebaseline data of patients (excluding patients with hypertension), the logistic regression analysis still found that smaller femoral artery diameter was the risk factor of the technical failure [OR=0.419, 95%CI (0.205, 0.860), P=0.018].Conclusions UGTI in treatment of IFAP is minimally invasive and has a higher technical success rate. Smaller femoral artery diameter might affect technical success rate of UGTI.

Citation： MA Jinman, WANG Tiehao, WU Zhoupeng, LIU Chuncheng, WEN Xiaorong, YUAN Ding, MA Yukui, ZHAO Jichun. Clinical application of ultrasound-guided thrombin injection in treatment of iatrogenic femoral artery pseudoaneurysm. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(7): 892-897. doi: 10.7507/1007-9424.202102028 Copy

1.	Mohammad F, Kabbani L, Lin J, et al. Post-procedural pseudoaneurysms: Single-center experience. Vascular, 2017, 25(2): 178-183.
2.	Dencker D, Pedersen F, Engstrøm T, et al. Major femoral vascular access complications after coronary diagnostic and interventional procedures: A Danish register study. Int J Cardiol, 2016, 202: 604-608.
3.	Dzijan-Horn M, Langwieser N, Groha P, et al. Safety and efficacy of a potential treatment algorithm by using manual compression repair and ultrasound-guided thrombin injection for the management of iatrogenic femoral artery pseudoaneurysm in a large patient cohort. Circ Cardiovasc Interv, 2014, 7(2): 207-215.
4.	Moll R, Habscheid W, Landwehr P. The frequency of false aneurysms of the femoral artery following heart catheterization and PTA (percutaneous transluminal angioplasty). Rofo, 1991, 154(1): 23-27.
5.	Shvarts M, Weiss D, Borochov A. Temperature effects on growth, pigmentation and post-harvest longevity of petunia flowers. Sci Hortic, 1997, 69(3-4): 217-227.
6.	Vergaro G, Emdin M, Del Corso A. Correction of procedural arterial pseudoaneurysms: established and novel procedures. Expert Rev Cardiovasc Ther, 2014, 12(7): 843-850.
7.	Houlind K, Jepsen JM, Saicu C, et al. Current management of inguinal false aneurysms. J Cardiovasc Surg (Torino), 2017, 58(2): 278-283.
8.	Ahmad F, Turner SA, Torrie P, et al. Iatrogenic femoral artery pseudoaneurysms—a review of current methods of diagnosis and treatment. Clin Radiol, 2008, 63(12): 1310-1316.
9.	Hanson J M, Atri M, Power N. Ultrasound-guided thrombin injection of iatrogenic groin pseudoaneurysm: Doppler features and technical tips. Br J Radiol, 2008, 81(962): 154-163.
10.	Webber GW, Jang J, Gustavson S, et al. Contemporary management of postcatheterization pseudoaneurysms. Circulation, 2007, 115(20): 2666-2674.
11.	La Perna L, Olin JW, Goines D, et al. Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. Circulation, 2000, 102(19): 2391-2395.
12.	de Oliveira Leite TF, Bortolini E, Linard B, et al. Evaluation of morphological and clinical factors related to failure of percutaneous treatment with thrombin injection of femoral pseudoaneurysms from cardiac catheterization. Ann Vasc Surg, 2019, 59: 173-183.
13.	Valesano JC, Schmitz JJ, Kurup AN, et al. Outcomes of ultrasound-guided thrombin injection of nongroin arterial pseudoaneurysms. J Vasc Interv Radiol, 2017, 28(8): 1156-1160.
14.	Esterson YB, Pellerito JS. Recurrence of thrombin-injected pseudoaneurysms under ultrasound guidance: A 10-year retrospective analysis. J Ultrasound Med, 2017, 36(8): 1617-1624.
15.	Delf J, Ramachandran S, Mustafa S, et al. Factors associated with pseudoaneurysm development and necessity for reintervention: a single centre study. Br J Radiol, 2019, 92(1098): 20180893.
16.	Kontopodis N, Tsetis D, Tavlas E, et al. Ultrasound guided compression versus ultrasound guided thrombin injection for the treatment of post-catheterization femoral pseudoaneurysms: systematic review and meta-analysis of comparative studies. Eur J Vasc Endovasc Surg, 2016, 51(6): 815-823.
17.	Rooke TW, Hirsch AT, Misra S, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine, and Society for Vascular Surgery. J Vasc Surg, 2011, 54(5): e32-e58.
18.	Cossman DV, Ellison JE, Wagner WH, et al. Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities. J Vasc Surg, 1989, 10(5): 522-528.
19.	Gao M, Hua Y, Zhao X, et al. Optimal ultrasound criteria for grading stenosis of the superficial femoral artery. Ultrasound Med Biol, 2018, 44(2): 350-358.
20.	Ranke C, Creutzig A, Alexander K. Duplex scanning of the peripheral arteries: correlation of the peak velocity ratio with angiographic diameter reduction. Ultrasound Med Biol, 1992, 18(5): 433-440.
21.	de Smet AA, Ermers EJ, Kitslaar PJ. Duplex velocity characteristics of aortoiliac stenoses. J Vasc Surg, 1996, 23(4): 628-636.
22.	Sipoş C, Salca H, Popa V. Ultrasonographic study of normal and pathological hemodynamics in the arterial vertebro-basilar system. Rom J Neurol Psychiatry, 1994, 32(1): 57-62.
23.	Cozzarin A, Marambio GM, Ferreiro DE, et al. Detection of angiographically significant coronary obstruction using resting transthoracic coronary Doppler echocardiography. J Echocardiogr, 2018, 16(3): 139-146.
24.	柳兆荣, 李惜惜. 血液动力学原理和方法. 上海: 血液动力学原理和方法, 1997.
25.	Papathanasopoulou P, Zhao S, Köhler U, et al. MRI measurement of time-resolved wall shear stress vectors in a carotid bifurcation model, and comparison with CFD predictions. J Magn Reson Imaging, 2003, 17(2): 153-162.
26.	Olsen DM, Rodriguez JA, Vranic M, et al. A prospective study of ultrasound scan-guided thrombin injection of femoral pseudoaneurysm: a trend toward minimal medication. J Vasc Surg, 2002, 36(4): 779-782.
27.	Chen DH, Sammel AM, Jain P, et al. Cardiologist operated ultrasound guided thrombin injection as a safe and efficacious first line treatment for iatrogenic femoral artery pseudoaneurysms. Heart Lung Circ, 2015, 24(2): 165-172.
28.	Shatnawi NJ, Al-Zoubi NA, Jarrah J, et al. Risk factors attributed to failure of ultrasound-guided compression for post-cardiac catheterization femoral artery pseudoaneurysms. SAGE Open Med, 2019, 7: 2050312119843705.
29.	Huang TL, Liang HL, Huang JS, et al. Ultrasound-guided compression repair of peripheral artery pseudoaneurysm: 8 years’ experience of a single institute. J Chin Med Assoc, 2012, 75(9): 468-473.
30.	Yang EY, Tabbara MM, Sanchez PG, et al. Comparison of ultrasound-guided thrombin injection of iatrogenic pseudoaneurysms based on neck dimension. Ann Vasc Surg, 2018, 47: 121-127.
31.	Schaub F, Theiss W, Busch R, et al. Management of 219 consecutive cases of postcatheterization pseudoaneurysm. J Am Coll Cardiol, 1997, 30(3): 670-675.

1. Mohammad F, Kabbani L, Lin J, et al. Post-procedural pseudoaneurysms: Single-center experience. Vascular, 2017, 25(2): 178-183.
2. Dencker D, Pedersen F, Engstrøm T, et al. Major femoral vascular access complications after coronary diagnostic and interventional procedures: A Danish register study. Int J Cardiol, 2016, 202: 604-608.
3. Dzijan-Horn M, Langwieser N, Groha P, et al. Safety and efficacy of a potential treatment algorithm by using manual compression repair and ultrasound-guided thrombin injection for the management of iatrogenic femoral artery pseudoaneurysm in a large patient cohort. Circ Cardiovasc Interv, 2014, 7(2): 207-215.
4. Moll R, Habscheid W, Landwehr P. The frequency of false aneurysms of the femoral artery following heart catheterization and PTA (percutaneous transluminal angioplasty). Rofo, 1991, 154(1): 23-27.
5. Shvarts M, Weiss D, Borochov A. Temperature effects on growth, pigmentation and post-harvest longevity of petunia flowers. Sci Hortic, 1997, 69(3-4): 217-227.
6. Vergaro G, Emdin M, Del Corso A. Correction of procedural arterial pseudoaneurysms: established and novel procedures. Expert Rev Cardiovasc Ther, 2014, 12(7): 843-850.
7. Houlind K, Jepsen JM, Saicu C, et al. Current management of inguinal false aneurysms. J Cardiovasc Surg (Torino), 2017, 58(2): 278-283.
8. Ahmad F, Turner SA, Torrie P, et al. Iatrogenic femoral artery pseudoaneurysms—a review of current methods of diagnosis and treatment. Clin Radiol, 2008, 63(12): 1310-1316.
9. Hanson J M, Atri M, Power N. Ultrasound-guided thrombin injection of iatrogenic groin pseudoaneurysm: Doppler features and technical tips. Br J Radiol, 2008, 81(962): 154-163.
10. Webber GW, Jang J, Gustavson S, et al. Contemporary management of postcatheterization pseudoaneurysms. Circulation, 2007, 115(20): 2666-2674.
11. La Perna L, Olin JW, Goines D, et al. Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. Circulation, 2000, 102(19): 2391-2395.
12. de Oliveira Leite TF, Bortolini E, Linard B, et al. Evaluation of morphological and clinical factors related to failure of percutaneous treatment with thrombin injection of femoral pseudoaneurysms from cardiac catheterization. Ann Vasc Surg, 2019, 59: 173-183.
13. Valesano JC, Schmitz JJ, Kurup AN, et al. Outcomes of ultrasound-guided thrombin injection of nongroin arterial pseudoaneurysms. J Vasc Interv Radiol, 2017, 28(8): 1156-1160.
14. Esterson YB, Pellerito JS. Recurrence of thrombin-injected pseudoaneurysms under ultrasound guidance: A 10-year retrospective analysis. J Ultrasound Med, 2017, 36(8): 1617-1624.
15. Delf J, Ramachandran S, Mustafa S, et al. Factors associated with pseudoaneurysm development and necessity for reintervention: a single centre study. Br J Radiol, 2019, 92(1098): 20180893.
16. Kontopodis N, Tsetis D, Tavlas E, et al. Ultrasound guided compression versus ultrasound guided thrombin injection for the treatment of post-catheterization femoral pseudoaneurysms: systematic review and meta-analysis of comparative studies. Eur J Vasc Endovasc Surg, 2016, 51(6): 815-823.
17. Rooke TW, Hirsch AT, Misra S, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine, and Society for Vascular Surgery. J Vasc Surg, 2011, 54(5): e32-e58.
18. Cossman DV, Ellison JE, Wagner WH, et al. Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities. J Vasc Surg, 1989, 10(5): 522-528.
19. Gao M, Hua Y, Zhao X, et al. Optimal ultrasound criteria for grading stenosis of the superficial femoral artery. Ultrasound Med Biol, 2018, 44(2): 350-358.
20. Ranke C, Creutzig A, Alexander K. Duplex scanning of the peripheral arteries: correlation of the peak velocity ratio with angiographic diameter reduction. Ultrasound Med Biol, 1992, 18(5): 433-440.
21. de Smet AA, Ermers EJ, Kitslaar PJ. Duplex velocity characteristics of aortoiliac stenoses. J Vasc Surg, 1996, 23(4): 628-636.
22. Sipoş C, Salca H, Popa V. Ultrasonographic study of normal and pathological hemodynamics in the arterial vertebro-basilar system. Rom J Neurol Psychiatry, 1994, 32(1): 57-62.
23. Cozzarin A, Marambio GM, Ferreiro DE, et al. Detection of angiographically significant coronary obstruction using resting transthoracic coronary Doppler echocardiography. J Echocardiogr, 2018, 16(3): 139-146.
24. 柳兆荣, 李惜惜. 血液动力学原理和方法. 上海: 血液动力学原理和方法, 1997.
25. Papathanasopoulou P, Zhao S, Köhler U, et al. MRI measurement of time-resolved wall shear stress vectors in a carotid bifurcation model, and comparison with CFD predictions. J Magn Reson Imaging, 2003, 17(2): 153-162.
26. Olsen DM, Rodriguez JA, Vranic M, et al. A prospective study of ultrasound scan-guided thrombin injection of femoral pseudoaneurysm: a trend toward minimal medication. J Vasc Surg, 2002, 36(4): 779-782.
27. Chen DH, Sammel AM, Jain P, et al. Cardiologist operated ultrasound guided thrombin injection as a safe and efficacious first line treatment for iatrogenic femoral artery pseudoaneurysms. Heart Lung Circ, 2015, 24(2): 165-172.
28. Shatnawi NJ, Al-Zoubi NA, Jarrah J, et al. Risk factors attributed to failure of ultrasound-guided compression for post-cardiac catheterization femoral artery pseudoaneurysms. SAGE Open Med, 2019, 7: 2050312119843705.
29. Huang TL, Liang HL, Huang JS, et al. Ultrasound-guided compression repair of peripheral artery pseudoaneurysm: 8 years’ experience of a single institute. J Chin Med Assoc, 2012, 75(9): 468-473.
30. Yang EY, Tabbara MM, Sanchez PG, et al. Comparison of ultrasound-guided thrombin injection of iatrogenic pseudoaneurysms based on neck dimension. Ann Vasc Surg, 2018, 47: 121-127.
31. Schaub F, Theiss W, Busch R, et al. Management of 219 consecutive cases of postcatheterization pseudoaneurysm. J Am Coll Cardiol, 1997, 30(3): 670-675.

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Clinical application of ultrasound-guided thrombin injection in treatment of iatrogenic femoral artery pseudoaneurysm

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