Cardiologist Operated Ultrasound Guided Thrombin Injection as a Safe and Efficacious First Line Treatment for Iatrogenic Femoral Artery Pseudoaneurysms

2015 ◽  
Vol 24 (2) ◽  
pp. 165-172 ◽  
Author(s):  
Daniel H. Chen ◽  
Anthony M. Sammel ◽  
Pankaj Jain ◽  
Nigel S. Jepson
Keyword(s):  
Femoral Artery ◽  
Line Treatment ◽  
Thrombin Injection ◽  
Ultrasound Guided ◽  
First Line ◽  
First Line Treatment

A new approach to the treatment of post-catheterization pseudoaneurysms by ultrasound-guided tissue glue injection or ultrasound-guided thrombin injection depending on a late to early velocity index

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Zandecki ◽  
J Kurzawski ◽  
A Jaroszynska ◽  
L Piatek
Keyword(s):  
Treatment Method ◽  
Line Treatment ◽  
Thrombin Injection ◽  
Ultrasound Guided ◽  
First Line ◽  
Tissue Glue ◽  
Increased Risk ◽  
Psa Recurrence ◽  
Glue Injection ◽  
First Line Treatment

Abstract Background Ultrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are reports of the use of biologically-derived tissue glues (TG) instead of sole thrombin especially when UGTI was unsuccessful or in case of psA recurrence. TG are more potent procoagulants and may increase the procedure success rates at the cost of higher risk of complications in case too much substance escape into the patient's circulation during the procedure. TG are also more expensive than thrombin so they are often reserved for selected patients. We have previously identified a late to early velocity index (LEVI) <0.2 as a predictor of an increased risk of psA recurrence after standard UGTI. In the current paper we report our first experiences when the choice of the first-line treatment method was based on LEVI. Methods From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI <0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) and 26 had LEVI >0.2 and underwent UGTI. The injection set (containing human thrombin and fibrinogen) was used for UGTGI. Bovine thrombin was used for UGTI. Results The success rate was 100% and no psA recurrence was detected during 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 15 years of experience (0% vs. 13%, p=0.02). All complications were mild and transient and included clinical symptoms of paraesthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. Conclusion The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. Two examples of LEVI calculations Funding Acknowledgement Type of funding source: None

scholarly journals A Nine Case Series of Ultrasound-Guided Hydrostatic Reduction of Intussusception by Saline Enema

2013 ◽  
Vol 19 (1) ◽  
pp. 61-71
Author(s):  
Sornsupha Limchareon ◽  
Adisorn Boonyarit
Keyword(s):  
Case Series ◽  
Teaching Hospitals ◽  
Line Treatment ◽  
Ultrasound Guided ◽  
First Line ◽  
Hydrostatic Reduction ◽  
Pneumatic Reduction ◽  
Reduction Techniques ◽  
Enema Reduction ◽  
First Line Treatment

Non-surgical reduction of the intussusception is the first line treatment in children with intussusception. Among various radiological reduction techniques, barium enema reduction of the intussusception under fluoroscopy has been widely used in Thailand while pneumatic reduction under fluoroscopy has become popular in teaching hospitals. To our knowledge, ultrasound-guided hydrostatic reduction of the intussusception by saline enema (UGHSE) has never been used in Thailand. We reported 9 cases using UGHSE with 100% success rate without complication.

scholarly journals Endoscopic ultrasound guided radiofrequency ablation should replace surgery as the first line treatment of insulinomas

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S368-S369
Author(s):  
S. Dorot ◽  
A. Dancour ◽  
E. Goldin ◽  
P. Reissman ◽  
M. Ben-haim
Keyword(s):  
Radiofrequency Ablation ◽  
Endoscopic Ultrasound ◽  
Line Treatment ◽  
Ultrasound Guided ◽  
First Line ◽  
First Line Treatment

Comparison of two simple treatment algorithms for iatrogenic femoral artery pseudoaneurysm: ultrasound guided manual compression vs. ultrasound guided thrombin injection

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Stern ◽  
G Oezaslan ◽  
R Sansone ◽  
S Baasen ◽  
C Heiss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thrombin Injection ◽  
Manual Compression ◽  
Ultrasound Guided ◽  
First Line ◽  
Treatment Algorithms ◽  
Independent Risk Factors ◽  
Mean Time ◽  
First Line Treatment

Abstract Background Postcatheterization femoral pseudoaneurysm (PSA) is a common access site related complication after endovascular procedures with potentially deleterious effect on patient outcome. There is still lack of consensus about the optimal treatment. Objective We analyze the incidence of PSA in a large cohort of patients undergoing state of the art procedures in current cardiology, identify independent risk factors for PSA formation and assess our experience in PSA treatment comparing two simple treatment algorithms: ultrasound guided manual compression vs. ultrasound guided thrombin injection as a first line treatment. Methods and results In this single-centre, retrospective study 29.802 patients from January 2013 to May 2018 underwent femoral artery catheterization. Sheath removal was carried out according to standard operating procedures of the clinic. In 228 patients, a PSA was diagnosed. Thus, overall incidence of PSA amounted to 0.8%. Of 228 patients with a PSA, 117 (51%) patients were primarily treated with ultrasound guided manual compression with an overall success rate of 34% at next day follow up. All other patients (n=111, 49%) were primarily treated with ultrasound guided thrombin injection with an overall success rate of 99% at next day follow up. Low rates of periprocedural complications were noted with either hemostasis technique. Analysis of laboratory characteristics revealed that efficacy of ultrasound guided manual compression is dependent on INR whereas efficacy of ultrasound guided thrombin injection is independent of INR (p=0.0253). There was also a higher rate of significant hemoglobin drop with ultrasound guided manual compression versus ultrasound guided thrombin injection (0.78 mg/dl ± 0.09 vs 0.26 mg/dl ± 0.08, p=0.038). Time to mobilization was significantly shorter after ultrasound guided thrombin injection (UGTI: mean time 23.4 h ± 3.1 h, UGMC: mean time 27.1 h ± 10.2 h, p=0.0002). Multivariate logistic regression analysis revealed that female gender, age (>75 years), oral anticoagulation and anemia are independent risk factors for PSA formation. Conclusions Almost 0.8% of patients undergoing cardiac catheterization via femoral access acquire PSA, for which independent risk factors could be identified. Interventional cardiologist operated ultrasound guided thrombin injection is highly effective and safe as a first line treatment and reduces blood loss compared to ultrasound guided manual compression. Funding Acknowledgement Type of funding source: None

scholarly journals Choosing a treatment method for post-catheterization pseudoaneurysms guided by the late to early velocity index

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jacek Kurzawski ◽  
Lukasz Zandecki ◽  
Agnieszka Janion-Sadowska ◽  
Lukasz Piatek ◽  
Anna Jaroszynska ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Symptoms ◽  
Treatment Method ◽  
Line Treatment ◽  
Ultrasound Guided ◽  
First Line ◽  
Recurrence Rates ◽  
Increased Risk ◽  
Psa Recurrence ◽  
First Line Treatment

AbstractUltrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are also first reports of the use of biologically derived tissue glues (TG) instead of sole thrombin especially when UGTI was unsuccessful or in case of psA recurrence. Previously, we have established that a late to early velocity index (LEVI) < 0.2 could be a predictor of an increased risk of psA recurrence after standard UGTI. In this paper, we report our first experiences when the choice of the first-line treatment method was based on LEVI assessment. From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI < 0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) with biological TG and 26 had LEVI > 0.2 and they underwent UGTI. The injection set containing human thrombin and fibrinogen was used for UGTGI. Bovine thrombin was used for UGTI. The success rate was 100% and no psA recurrence was detected during a 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 14 years of experience (0% vs. 13%, p = 0.01). All complications (10% in the UGTGI group and 15% in the UGTI group) were mild and transient and included clinical symptoms of paresthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. It may increase the success rate and avoid unnecessary repetition of the procedure, without increasing complication rate while keeping costs of the procedure reasonable.

Sign in / Sign up

Export Citation Format

Share Document