İatrojenik Femoral Psödoanevrizmaların Ultrason Eşliğinde Trombin Enjeksiyonu ile Tedavisi: Tek Merkez Sonuçları

  • Mustafa Özdemir Türkiye Yüksek İhtisas EA Hastanesi, Ankara
  • Muharrem Tola Ankara Şehir Hastanesi, Radyoloji Kliniği
  • Fatma Ayça Edis Özdemir Ankara Şehir Hastanesi, Radyoloji Kliniği
  • Rıza Sarper Ökten Ankara Şehir Hastanesi, Radyoloji Kliniği

Abstract

Amaç: Bu çalışmanın amacı ultrason kılavuzluğunda perkütan trombin enjeksiyonu ile psödoanevrizma tedavisinin etkinliğini araştırmak ve kliniğimizin sonuçlarını literatür eşliğinde sunmaktır. Gereç ve Yöntemler: Ocak 2016 ile haziran 2018 tarihleri arasında iatrojenik femoral psödoanevrizma tanısı konulan toplam 58 hasta (28 erkek, 30 kadın, 64, 2 ± 7,8 yıl) çalışmaya dahil edildi. Toplam 62 lezyona ultrasonografi kılavuzluğunda perkütan thrombin (Tisseel, Baxter US) enjeksiyonu ile tedavi uygulandı. Demografik bulgular ve psödoanevrimaların özellikleri kaydedilerek, prosedürün etkinliği ve güvenilirliği incelendi. Bulgular: Psödoanevrizmaların %43’ ü (n; 27) ana femoral arterden, %52’ si (n; 32), süperfisiyal femoral arterden, % 5’i (n; 3) derin femoral arterden köken almaktaydı. Psödoanevrizmaların ortalama maksimum transvers çapı 41,4 ± 12,1 (21-76) mm idi. Ortalama boyun çapı 1,6 ± 0,49 (1-3) mm idi. Embolizasyon işleminden hemen sonra yapılan doppler kontrolünde renkle dolum izlenmediği için teknik başarı %100 olarak tespit edildi. İşlemden 24 saat sonra yapılan kontrolde 62 psödoanevrizmanın 6’ sında( % 9,6) kesenin tekrar dolduğu görüldü. Bunun sonucunda klinik başarı %90,4 olarak değerlendirildi. Renkle dolumun izlendiği lezyonlara işlem tekrarlandı. Rezidü doluş izlenen psödoanevrizma keselerinin tamamında gerçekleştirilen 2. işlem sonrasında komplet tromboz gözlendi. Embolizasyon işleminden sonra hiçbir hastada komplikasyon görülmedi. Sonuç: İatrojenik femoral psödoanevrizmaların tedavisinde ultrasonografi eşliğinde trombin enjeksiyonu yüksek başarı oranına sahip, kolay uygulanabilir, güvenli ve hastalar tarafından iyi tolere edilebilen bir yöntemdir.

Author Biographies

Mustafa Özdemir, Türkiye Yüksek İhtisas EA Hastanesi, Ankara
Radyoloji Kliniği, Uzman Doktor
Muharrem Tola, Ankara Şehir Hastanesi, Radyoloji Kliniği
Radyoloji Kliniği
Fatma Ayça Edis Özdemir, Ankara Şehir Hastanesi, Radyoloji Kliniği
Radyoloji Kliniği
Rıza Sarper Ökten, Ankara Şehir Hastanesi, Radyoloji Kliniği
Radyoloji Kliniği

References

Lenartova M, Tak T. Iatrogenic pseudoaneurysm of femoral artery: case report and literature review. Clin Med Res 2003;1:243–7.

Webber GW, Jang J, Gustavson S, Olin JW. Contemporary management of postcatheterization pseudoaneurysms. Circulation 2007;115(20):2666-74.

Schneider C, Malisius R, Küchler R, et al. A prospective study on ultrasound-guided percutaneous thrombin injection for treatment of iatrogenic post-catheterisation femoral pseudoaneurysms. Int J Cardiol 2009; 131: 356-61.

Gayed M, Yadak N, Qamhia W, Daralammouri Y, Ohlow MA. Comorbidities and complications in nonagenarians undergoing coronary angiography and intervention. Int Heart J 2017; 58: 180-4.

Lumsden AB, Miller JM, Kosinski AS, et al. A prospective evaluation of surgically treated groin complications following percutaneous cardiac procedures. Am Surg 1994; 60: 132-7.

Coley BD, Roberts AC, Fellmeth BD, Valji K, Bookstein JJ, Hye RJ. Postangiographic femoral artery pseudoaneurysms: further experience with US-guided compression repair. Radiology 1995;194(2):307-11.

Krueger K, Zaehringer M, Strohe D, Stuetzer H, Boecker J, Lackner K. Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology 2005;236(3):1104- 10.

Taylor BS, Rhee RY, Muluk S, et al. Thrombin injection versus compression of femoral artery pseudoaneurysms. J Vasc Surg 1999;30:1052–9.

Brophy DP, Sheiman RG, Amatulle P, et al. Iatrogenic femoral pseudoaneurysms: thrombin injection after failed US-guided compression. Radiology 2000;214:278–82.

Ferguson JD, Whatling PJ, Martin V, et al. Ultrasound guided percutaneous thrombin injection of iatrogenic femoral artery pseudoaneurysms after coronary angiography and intervention. Heart 2001;85:E5.

Sheldon PJ, Oglevie SB, Kaplan LA. Prolonged generalized urticarial reaction after percutaneous thrombin injection for treatment of a femoral artery pseudoaneurysm. J Vasc Interv Radiol 2000;11:759–61.

Morgan R, Belli AM. Current treatment methods for postcatheterization pseudoaneurysms. J Vasc Interv Radiol 2003;14:697–710.

Hanson JM, Atri M, Power N. Ultrasound-guided thrombin injection of iatrogenic groin pseudoaneurysm: Doppler features and technical tips. Br J Radiol 2008;81:154–63.

D’Ayala M, Smith R, Zanieski G, Fahoum B, Tortolani AJ. Acute arterial occlusion after ultrasound-guided thrombin injection of a common femoral artery pseudoaneurysm with a wide, short neck. Ann Vasc Surg 2008;3:473–5.

Kent KC, McArdle CR, Kennedy B, Baim DS, Anninos E, Skillman JJ. A prospective study of the clinical outcome of femoral pseudoaneurysms and arteriovenous fistulas induced by arterial puncture. J Vasc Surg 1993; 17: 125-31; discussion 131- 3.

Schaub F, Theiss W, Busch R, Heinz M, Paschalidis M, Schömig A. Management of 219 consecutive cases of postcatheterization pseudoaneurysm. J Am Coll Cardiol 1997; 30: 670-5.

Kang SS, Labropoulos N, Mansour MA, Baker WH. Percutaneous ultrasound guided thrombin injection: a new method for treating postcatheterization femoral pseudoaneurysms. J Vasc Surg 1998; 27: 1032-8.

Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol 2006; 47: 1239-312

Fellmeth BD, Roberts AC, Bookstein JJ, Freischlag JA, Forsythe JR, Buckner NK, et al. Postangiographic femoral artery injuries: nonsurgical repair with USguided compression. Radiology 1991;178(3):671-5.

Cox GS, Young JR, Gray BR, Grubb MW, Hertzer NR. Ultrasound-guided compression repair of postcatheterization pseudoaneurysms: results of treatment in one hundred cases. J Vasc Surg 1994;19(4):683-6.

Paschalidis M, Theiss W, Kölling K, Busch R, Schömig A. Randomised comparison of manual compression repair versus ultrasound guided compression repair of postcatheterisation femoral pseudoaneurysms. Heart 2006;92(2):251-2.

Ceylan M, Şahin S, Çelik L, Bilgin Ş. Arteriyel kateterizasyondan sonra görülen iyatrojenik femoral ve brakiyal psödoanevrizmaların renkli Doppler US eşliğinde kompresyonla tedavisi. Turk Gogus Kalp Dama 2004;12:287-92.

Chen G, Wu L, Zheng L, Ding L, Wong T, Zhang S, Yao Y. Combining Percutaneous Ultrasound-Guided Hematoma Aspiration and Compression Repair to Treat Femoral Artery Pseudoaneurysm after Cardiac Catheterization. Int Heart J. 2018 Mar 30;59(2):333-338.

Cope C, Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection. AJR Am J Roentgenol 1986;147(2):383-7.

Ahmad F, Turner SA, Torrie P, Gibson M. Iatrogenic femoral artery pseudoaneurysms--a review of current methods of diagnosis and treatment. Clin Radiol 2008;63(12):1310-6.

Şevki Murat Aksoy, İnanç Şamil Sarıcı, Adem Uçar, Fatih Yanar, Orhan Ağcaoğlu, Mehmet Kurtoğlu. Ultrasound-Guided Thrombin Injection for the Treatment of Iatrogenic Femoral Artery Pseudoaneurysms. Turkiye Klinikleri J Cardiovasc Sci 2014;26(1).

La Perna L, Olin JW, Goines D, Childs MB, Ouriel K. Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. Circulation 2000; 102: 2391- 5.

Zarge J, Villemure P, Mathewson C, Lawrence J, Byars J. Complications related to thrombin injection for pseudoaneurysm repair. J Vasc Tech 2001; 25: 209-12.

Sadiq S, Ibrahim W. Thromboembolism complicating thrombin injection of femoral artery pseudoaneurysm: management with intraarterial thrombolysis. J Vasc Interv Radiol 2001; 12: 633-6.

Stone PA, Campbell JE, Aburahma AF. Femoral pseudoaneurysms after percutaneous access. J Vasc Surg. 2014; 60(5):1359-1366.

Mlekusch W, Haumer M, Mlekusch I, Dick P, Steiner-Boeker S, Bartok A et al. Prediction of iatrogenic pseudoaneurysm after percutaneous endovascular procedures. Radiology. 2006; 240: 597–602.

Ayhan E, Isik T, Uyarel H, Ergelen R, Cicek G, Ghannadian B et al. Femoral pseudoaneurysm in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: incidence, clinical course and risk factors. Int Angiol. 2012; 31: 579–585.

Published
2019-06-22
Section
Original Research