Safety evaluation of percutaneous ultrasound-guided thrombin injection into pseudoaneurysms

Summary Introduction: common application of endovascular procedures is frequently connected with increasing risk of pseudoaneurysm at the site of the artery puncture. The most frequent method of treatment of aneurysms is percutaneus ultrasound-guided thrombin injection. The aim of this research was safety evaluation of treatment of pseudoaneurysm by thrombin injection based on own experience . Methods and materials: 70 people (53% women, 43% men, average age 67.9 ±10.5) with pseudoaneurysm and under ultrasound-guided thrombin injection treatment carried out between 2007 and 2018 in the Department of General and Vascular Surgery of Pirogow Hospital in Lodz were analysed. Patients were qualified to treatment based on aneurysm and channel morphology in ultrasound examination. Before application of medicine blood supply to the limb was clinically assessed and examined using sonography. The tip of the needle was imaged into the lumen of the aneurysm. Results: in the research group, average aneurysm diameter was 29.9mm (± 17.2) within a range from 10mm to 96mm. Multi-chamber aneurysm was detected in 21% of patients. Mean channel length was 12mm (±7.7), mean width 3.5mm (±1.4), mean thrombin injected 1.7ml (±0.7) within range from 0.5 to 4ml. The treatment was successful in 94% of cases. Complications after thrombin injection occurred in 7% of cases (1 patient suffered from shock, 1 from thrombus in the saphenous vein, 3 from thrombus moving from aneurysm neck to femoral artery). No deterioration of blood supply in a limb was detected after obliteration of aneurysm. No relevant differences in aneurysm and channel dimensions were detected between groups with and without complications (p > 0.05). Conclusions: obliteration of the pseudoaneurysm by percutaneous ultrasound-guided thrombin injection is a highly effective method. This method is considered as safe, however, it requires experience. Its application may cause complications of which some are clinically significant and may lead to health and life threatening situations. In some specific cases surgical treatment of choice should be considered.

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Primary Management of Large Pancreatic Pseudoaneurysm by Ultrasound-Guided Percutaneous Thrombin Injection after Failure of Transarterial Pseudoaneurysm Embolization

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0037-1603197 ◽

2017 ◽

Vol 01 (02) ◽

pp. 130-133

Author(s):

Pawan Garg ◽

Pushpinder Khera ◽

Rengarajan Rajagopal ◽

Neeraj Mehta ◽

Swarnava Tarafdar

Keyword(s):

Transarterial Embolization ◽

High Morbidity ◽

Thrombin Injection ◽

Ultrasound Guided ◽

First Line ◽

Risk Of Rupture ◽

Life Threatening ◽

Percutaneous Thrombin Injection ◽

Life Threatening Complication ◽

Primary Management

AbstractPancreatic pseudoaneurysm is a rare but life-threatening complication secondary to pancreatitis, surgery, trauma, or infection. Early treatment is advocated due to high risk of rupture and bleeding. Surgical treatment has traditionally been the first line but is associated with high morbidity. Transarterial embolization or exclusion is the treatment of choice; however, in cases with failure of endovascular treatment, percutaneous thrombin injection can be used successfully. We present a case of a large pancreatic pseudoaneurysm managed successfully with percutaneous ultrasound-guided thrombin injection after failure of transarterial management.

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A Serological Storm

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v9i2.42 ◽

1970 ◽

Vol 9 (2) ◽

Author(s):

Bertha Wong MD ◽

Maria Bagovich MD ◽

Ivan Blasutig PhD ◽

Simon Carette MD MPhil

Keyword(s):

Differential Diagnosis ◽

Hepatitis C Virus ◽

Immune System ◽

Hepatitis C ◽

Hcv Infection ◽

Clinical Context ◽

Autoantibody Profile ◽

Life Threatening ◽

Clinically Significant ◽

Sensory Polyneuropathy

This article describes a patient presenting with a sensory polyneuropathy and multiple autoantibodies, leading to the diagnosis of hepatitis C virus (HCV) infection. His widely positive autoantibody profile in the absence of clinically significant rheumatic disease illustrates the importance of interpreting autoimmune serology in the appropriate clinical context and the concept of HCV being a non-specific activator of the immune system. In addition, it highlights the importance of considering untreated HCV infection in the differential diagnosis of rheumatic complaints, particularly if the workup reveals multiple autoantibodies, as HCV is a potentially severe and life-threatening disease, which can be appropriately managed with effective antiviral therapy.

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Ultrasound‐Guided Thrombin Injection for the Treatment of Bleeding Following Kidney and Liver Biopsies

Journal of Ultrasound in Medicine ◽

10.1002/jum.15699 ◽

2021 ◽

Author(s):

Mark J. Hoegger ◽

William D. Middleton

Keyword(s):

Thrombin Injection ◽

Ultrasound Guided ◽

Liver Biopsies

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Ultrasound-guided Thrombin Injection for Management of Iatrogenic Pseudoaneurysm: A National Institutional Experience

10.1055/s-0041-1729829 ◽

2017 ◽

Author(s):

Alharbi Abdulaziz ◽

Guzaiz Noha ◽

Qazi Shahbaz ◽

Salman Refaat

Keyword(s):

Thrombin Injection ◽

Ultrasound Guided ◽

Institutional Experience ◽

Iatrogenic Pseudoaneurysm

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Application of ultrasound-guided intranodal lymphangiography and embolisation in cancer patients with postoperative lymphatic leakage

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02144-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Xingwei Sun ◽

Feng Zhou ◽

Xuming Bai ◽

Qiang Yuan ◽

Mingqing Zhang ◽

...

Keyword(s):

Cancer Patients ◽

Operative Time ◽

Length Of Hospital Stay ◽

Chylous Ascites ◽

Pelvic Surgery ◽

Ultrasound Guided ◽

Technical Success Rate ◽

Life Threatening ◽

Low Incidence ◽

Intranodal Lymphangiography

Abstract Background Traumatic lymphatic leakage is a rare but potentially life-threatening complication. The purpose of this study was to introduce ultrasound-guided intranodal lymphangiography and embolisation techniques for postoperative lymphatic leakage in patients with cancer. Methods From January 2018 through June 2020, seven cancer patients (three males, four females, aged 59–75 years [mean 67.57 ± 6.11 years]) developed lymphatic leakage after abdominal or pelvic surgery, with drainage volumes ranging from 550 to 1200 mL per day. The procedure and follow-up of ultrasound-guided intranodal lymphangiography and embolisation were recorded. This study retrospectively analysed the technical success rate, operative time, length of hospital stay, clinical efficacy, and complications. Results The operation was technically successful in all patients. Angiography revealed leakage, and embolisation was performed in all seven patients (7/7, 100%). The operative time of angiography and embolisation was 41 to 68 min, with an average time of 53.29 ± 10.27 min. The mean length of stay was 3.51 ± 1.13 days. Lymph node embolisation was clinically successful in five patients (5/7, 71.43%), who had a significant reduction in or disappearance of chylous ascites. The other two patients received surgical treatment 2 weeks later due to poor results after embolisation. All patients were followed for 2 weeks. No serious complications or only minor complications were found in all the patients. Conclusions Ultrasound-guided intranodal lymphangiography and embolisation were well tolerated by the patients, who experienced a low incidence of complications. Early intervention is recommended for cancer patients with postoperative lymphatic leakage.

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The bowel and beyond: extracolonic findings from CT colonography

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02595-2 ◽

2021 ◽

Author(s):

Gerard Lambe ◽

Peter Hughes ◽

Louise Rice ◽

Caoimhe McDonnell ◽

Mark Murphy ◽

...

Keyword(s):

Ct Colonography ◽

Surgical Intervention ◽

Potential Significance ◽

Age And Gender ◽

Abdominal Aortic ◽

Life Threatening ◽

Extracolonic Findings ◽

The Difference ◽

Clinically Significant ◽

And Gender

AbstractCT colonography has emerged as the investigation of choice for suspected colorectal cancer in patients when a colonoscopy in incomplete, is deemed high risk or is declined because of patient preference. Unlike a traditional colonoscopy, it frequently reveals extracolonic as well as colonic findings. Our study aimed to determine the prevalence, characteristics and potential significance of extracolonic findings on CT colonography within our own institution. A retrospective review was performed of 502 patients who underwent CT colonography in our institution between January 1, 2010 and January 4, 2015. Of 502 patients, 60.63% had at least one extracolonic finding. This was close to other similar-sized studies (Kumar et al. Radiology 236(2):519–526, 2005). However, our rate of E4 findings was significantly higher than that reported in larger studies at 5.3%(Pooler et al. AJR 206:313–318, 2016). The difference may be explained by our combination of symptomatic/screening patients or by the age and gender distribution of our population. Our study lends support to the hypothesis that CT colonography may be particularly useful in identifying clinically significant extracolonic findings in symptomatic patients. CT colonography may allow early identification of extracolonic malignancies and life-threatening conditions such as an abdominal aortic aneurysm at a preclinical stage when they are amenable to medical or surgical intervention. However, extracolonic findings may also result in unnecessary investigations for subsequently benign findings.

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