Thrombin injection versus compression of femoral artery pseudoaneurysms

• Published in: Journal of vascular surgery Vol. 30; no. 6; pp. 1052 - 1059
• Main Authors: Taylor, Bradley S., Rhee, Robert Y., Muluk, Satish, Trachtenberg, Jeffrey, Walters, Doreen, Steed, David L., Makaroun, Michel S.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-12-1999
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm, False - diagnostic imaging; Aneurysm, False - therapy; Female; Femoral Artery - diagnostic imaging; Hemostatic Techniques; Humans; Injections, Intra-Arterial; Male; Middle Aged; Pain Measurement; Pressure; Retrospective Studies; Thrombin - administration & dosage; Treatment Outcome; Ultrasonography
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/S0741-5214(99)70043-1

Objective: The compression of femoral artery pseudoaneurysms is a time consuming, painful, and sometimes unsuccessful procedure. Thrombin injection has been advocated as a superior alternative. In this study, we compare our experiences with both techniques.
Methods: All the records of femoral artery false aneurysms that were treated in the vascular laboratory from January 1996 to April 1999 were retrospectively reviewed. Treatment with ultrasound scan–guided compression was compared with treatment with dilute thrombin injection (100 U/mL).
Results: Both groups had similar demographics and aneurysm sizes (
P > .2). Of the pseudoaneursyms, 88% were caused by cardiac catheterization and the others were the results of femoral artery access for cardiac surgery (6%), arteriography (5%), and renal dialysis (1%). Compression was successful in 25 of 40 patients (63%). Nine persistent aneurysms necessitated operation, and six were treated successfully with thrombin injection. Primary thrombin injection successfully obliterated 21 pseudoaneurysms in 23 patients. Overall, 27 of 29 pseudoaneurysms were treated successfully with thrombin injection (93%). Thrombosis occurred within seconds of the thrombin injection and required, on average, 300 units of thrombin (100 to 600 units). The patients who underwent successful compression required an average of 37 minutes of compression (range, 5 to 70 minutes) and required analgesia on several occasions. No patients in the thrombin group required analgesia or sedation. Neither group had complications. A cost analysis shows that thrombin treatment results in considerable savings in vascular laboratory resource use but not in overall hospital expenditures.
Conclusion: Ultrasound scan–guided thrombin injection is a safe, fast, and painless procedure that completely obliterates femoral artery pseudoaneurysms. The shift from compressive therapy to thrombin injection reduces vascular laboratory use and is less expensive, although it does not significantly impact hospital costs. (J Vasc Surg 1999;30:1052-9.)