Die Behandlung iatrogener femoraler Pseudoaneurysmen durch Thrombininjektion - Ergebnisse bei 54 Patienten

Zusammenfassung

Ziel: Klärung der Frage, ob die sonographisch gesteuerte perkutane Thrombininjektion eine geeignete Methode ist, um iatrogene Pseudoaneurysmen der punktierten Femoralarterie nach Kathetereingriffen zu thrombosieren. Material und Methode: In einem Zeitraum von 2 Jahren und 11 Monaten wurde bei 54 Patienten (m : w = 29 : 25) ein iatrogenes Pseudoaneurysma (n = 55) der Arteria femoralis unter kontinuierlicher duplexsonographischer Kontrolle durch perkutane Thrombininjektion therapiert. Der Maximaldurchmesser des perfundierten Pseudoaneurysmalumens betrug im Mittel 2,5 ± 1 cm. Die injizierte Thrombinmenge lag zwischen 10 und 2000 E (Median: 200 E). Ergebnisse: Die Verschlussrate durch Thrombininjektion betrug 100 % (n = 55/55). 54 von 55 Pseudoaneurysmen (98 %) konnten vollständig und dauerhaft thrombosiert werden. Bei 6 Pseudoaneurysmen waren dazu 2 Sitzungen nötig. Bei einem von 55 Pseudoaneurysmen (2 %) bildete sich innerhalb von 24 Stunden nach einer primär vollständigen Thrombosierung ein kleines reperfundiertes Lumen von 3 × 5 mm aus, welches später spontan thrombosierte. Komplikationen, insbesondere eine klinisch manifeste Thrombembolie, traten nicht auf. Schlussfolgerung: Die sonographisch gesteuerte perkutane Thrombininjektion ist eine sehr effektive und sichere Methode zum Verschluss iatrogener Pseudoaneurysmen nach Kathetereingriffen.

Abstract

Purpose: To evaluate ultrasound-guided percutaneous thrombin injection to treat iatrogenic femoral pseudoaneurysms following catheter interventions. Materials and Methods: In a period of 2 years and 11 months, 55 iatrogenic femoral pseudoaneurysms were treated in 54 patients (male : female = 29 : 25) by percutaneous thrombin injection under continuous color Doppler control. Mean maximum diameter of the perfused lumen was 2.5 cm (SD ± 1 cm). The injected thrombin dosis varied between 10 and 2,000 U (median 200 U). Results: Following thrombin injection, the pseudoaneurysm occlusion rate was 100 % (n = 55/55). Complete and persistent occlusion was achieved in 54 of 55 (98 %) pseudoaneurysms. A repeated procedure was necessary in 6 pseudoaneurysms. In one case (2 %), discrete signs of reperfusion were observed after primary occlusion within 24 hours of the initial procedure (lumen diameter 3 × 5 mm), followed by spontaneous thrombosis without further treatment. No complications, in particular no clinically manifest thromboembolic events, were observed. Conclusion: Ultrasound-guided percutaneous thrombin injection is an effective and safe method for the treatment of iatrogenic postcatheterization femoral pseudoaneurysms.

Key words

Peripheral arteries - angiography complications - aneurysm therapy - thrombosis - ultrasound guidance - interventional procedures

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