High incidence of deep vein thrombosis during the treatment of pseudoaneurysms – a retrospective nonrandomized study
Abstract
Summary:Background: Pseudoaneurysms (PSAs) are concerning complications after arterial invasive interventions. Therapeutic options include manual ultrasound-assisted compression, pressure dressings, surgical intervention and thrombin injection. Compression of neighboring veins is obvious. However, the incidence of deep vein thrombosis (DVT) in patients with PSA has not previously been investigated. Patients and methods: In this retrospective, nonrandomized study 238 patients with PSA were analyzed from 2013 to 2018. In 149 patients, all of the parameters were complete for participating. PSAs were treated according to the local standard therapy with either ultrasound-guided compression followed by compression bandage or thrombin injection. Treatment success was evaluated 24 hours later, and the venous system was examined for the presence of DVT. Results: Peripheral DVT was found in 25.4% patients after ultrasound-assisted compression and subsequent pressure bandages, but only 6.4% of patients had DVT after thrombin injection (p = 0.013). Lower leg veins, particularly veins of the crural muscles, were primarily affected. Significantly more PSAs were successfully treated without the occurrence of DVT in the thrombin injection group compared to the compression group (93.6 vs. 69.0%; p = 0.001). Conclusions: Our study revealed that the use of thrombin injections resulted in a significantly lower rate of postinterventional DVT and a higher total number of successfully treated PSAs compared to compression therapy.
References
1 ESVM guideline on peripheral arterial disease. VASA. 2019;48:1–79.
2 Nonsurgical closure of femoral pseudoaneurysms complicating cardiac catheterization and percutaneous transluminal coronary angioplasty. J Am Coll Cardiol. 1992;20:610–5.
3 . Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J. 2010;159:518–31.
4 . Pseudoaneurysm. Haemostaseologie. 2018;38:166–72.
5 . Modern finding-specific and patient-adapted management of peripheral pseudoaneurysms after arterial access. Zentralbl Chir. 2020;145:438–44.
6 . Incidence and results of arterial complications among 16,350 patients undergoing cardiac catheterization. J Vasc Surg. 1989;10:113–6.
7 . Surgical treatment of femoral pseudoaneurysm following cardiac catheterization. Cardiovasc Surg. 1993;1:118–21.
8 Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression. Radiology. 1991;178:671–5.
9 . Do not underestimate the femoral pseudoaneurysm. VASA. 2018;47:177–85.
10 Percutaneous injection of thrombin for the treatment of pseudoaneurysms: the German multicentre registry. EuroIntervention. 2007;3:321–6.
11 Incidence of bleeding and compliance on prolonged dual antiplatelet therapy (aspirin + thienopyridine) following drug-eluting stent implantation. Am J Cardiol. 2008;102:1477–81.
12 . Management of 219 consecutive cases of postcatheterization pseudoaneurysm. J Am Coll Cardiol. 1997;30:670–5.
13 Femoral pseudoaneurysms and current cardiac catheterization: evaluation of risk factors and treatment. Int J Cardiol. 2010;141:75–80.
14 . Virchow’s triad revisited. South Med J. 2004;97:213–4.
15 . Coagulation of aneurysms by direct percutaneous thrombin injection. Am J Roentgenol. 1986;147:383–7.
16 The accuracy of color Doppler flow imaging for the detection of symptomatic deep venous thrombosis in Chinese patients. Surg Today. 1996;26:683–7.
17 . The management of peripheral arterial aneurysms using percutaneous injection of fibrin adhesive. Br J Radiol. 1998;71:1255–9.
18 Efficacy and safety of percutaneous treatment of iatrogenic femoral artery pseudoaneurysm by biodegradable collagen injection. J Am Coll Cardiol. 2002;39:1297–304.
19 . Percutaneous treatment of iatrogenic pseudoaneurysms by cyanoacrylate-based wall-gluing. Cardiovasc Intervent Radiol. 2013;36:669–75.
20 . Closure of an iatrogenic femoral artery pseudoaneurysm by transcutaneous coil embolization. Cathet Cardiovasc Diagn. 1996;39:317–9.
21 Treatment of post-catheterization femoral artery pseudo-aneurysm with para-aneurysmal saline injection. Am J Cardiol. 2008;101:1418–22.
22 . Sonographic follow-up of the access site after arterial angiography: impact on the detected complication rate. J Ultrasound Med. 2009;28:1151–7.
23 . Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. Circulation. 2000;102:2391–5.
24 . Die Unterschenkelvenenthrombose – Eine Erkrankung für Spezialisten. Phlebologie. 2019;47:319–28.
25 . Femoral artery pseudoaneurysms: value of color Doppler sonography in predicting which ones will thrombose without treatment. AJR Am J Roentgenol. 1992;159:1077–81.
26 . Comparison of the efficacy and safety of two dosing protocols for ultrasound guided thrombin injection in patients with iatrogenic femoral pseudoaneurysms. Eur J Vasc Endovasc Surg. 2020;59:1019–25.
27 Interdisziplinäre S2k: Leitlinie: Diagnostik und Therapie der Bein- und Beckenvenenthrombose und der Lungenembolie; Registernummer 065–002. VASA. 2016;45:1–48.
28 . Incidence of pulmonary embolism in patients with isolated calf deep vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2017;5:274–9.
29 Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med. 2010;152:218–24.
30 . Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis. J Thromb Haemost. 2016;14:964–72.