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

Main Article Content

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.

Article Details

Section
Original Research
Author Biography

, Türkiye Yüksek İhtisas EA Hastanesi, Ankara

Radyoloji Kliniği, Uzman Doktor

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.