| Abstrakt: |
Introduction Duplex-guided thrombin injection (DGTI) has been shown to be a safe and efficacious initial treatment of iatrogenic arterial pseudoaneurysms. Postinjection follow-up duplex ultrasound examination has become the accepted standard of care despite 1) the use of intraprocedural ultrasonography to monitor successful thrombosis, 2) a low post-DGTI recurrence rate, and 3) the relatively high cost of ultrasonography. A retrospective study of DGTI at our institution was conducted to examine the necessity of routine duplex ultrasound after successful DGTI, along with a review of the relevant literature.Patient Population/Methods A retrospective review was conducted of 82 patients with iatrogenic arterial pseudoaneurysms (12 complex; 25.6%) treated with DGTI after initial diagnostic duplex ultrasonography. Immediate routine follow-up duplex ultrasound was performed on 71 of 82 cases (86.6%), whereas 11 patients received only clinical follow-up at the surgeon's discretion. Patient demographics, pseudoaneurysm anatomy, procedural details, outcomes, and complications were retrospectively documented and analyzed.Results From January 2002 to November 2003, 82 patients (59.8% women) underwent DGTI for pseudoaneurysm, with the majority located in the common femoral artery (48 of 82; 58.5%). Eighty pseudoaneurysms (97.6%) were treated with DGTI, with 78 (95.1%) being initially successful. Four of 78 (5%) follow-up examinations were judged to be of clinical significance: 2 of 78 patients (2.6%) became symptomatic and experienced pseudoaneurysm recurrence, whereas 2 of 78 patients were found to have an additional, previously undocumented, pseudoaneurysm. Three of these four resolved with a second injection, whereas one resolved without additional treatment. No thromboembolic, allergic, or infectious complications related to DGTI occurred.Conclusions In concert with the available literature, this cohort confirms that DGTI is a safe and effective treatment of iatrogenic arterial pseudoaneurysms with a low rate of recurrence, complication, and need for conversion to surgical intervention. DGTI should undoubtedly be the initial treatment of choice for pseudoaneurysms; however, follow-up duplex ultrasonography can be reserved for the clinically symptomatic patient. |
