Fatal Complication after Thrombin Injection for Post-Catheterization Femoral Pseudoaneurysm

Abstract

Femoral artery pseudoaneurysm (FAP) is one of the most common vascular complications after cardiac and peripheral angiographic procedures. Ultrasound-guided thrombin injection is the standard procedure for the treatment of FAP. Complications such as thrombotic events with leg ischemia after thrombin leakage into the femoral artery or immunogenic consequences are rare. Our experience indicates the need for caution when treating FAP, as severe complications can occur after thrombin injection in a femoral pseudoaneurysm, leading to a fatal event.

Cardiac catheterization/intervention (incl. PCI) - inflammation - systemic (incl. cells, mediators) - ischemia/reperfusion - peripheral vascular disease (outside the chest) - surgery - complications - femoral pseudoaneurysm - distal embolization - iatrogenic complications

References

• 1 Hessel S J, Adams D F, Abrams H L. Complications of angiography.  Radiology. 1981;  138 273-281
• 2 Maleux G, Hendrickx S, Vaninbroukx J et al. Percutaneous injection of human thrombin to treat iatrogenic femoral pseudoaneurysms: short and midterm ultrasound follow-up.  Eur Radiol. 2003;  13 209-212
• 3 Olsen D M, Rodriguez J A, Vranic M et al. A prospective study of ultrasound injection of femoral pseudoaneurysm: a trend toward minimal medication.  J Vasc Surg. 2002;  36 779-782
• 4 Cope C, Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection.  AJR. 1986;  147 383-387
• 5 Powell A, Benenati J F, Becker G J, Katzen B T, Zemel G. Percutaneous ultrasound-guided thrombin injection for the treatment of pseudoaneurysms.  J Am Coll Surg. 2002;  194 S53-S57
• 6 Pope M, Johnson K W. Anaphylaxis after thrombin injection of a femoral pseudoaneurysm: recommendations for prevention.  J Vasc Surg. 2000;  32 190-191
• 7 Muntaen W, Zenz W, Edlinger G. Severe bleeding due to factor V inhibitor after repeated operations using fibrin sealant containing bovine thrombin.  Thromb Haemost. 1997;  77 1223
• 8 D'Ayala M, Smith R, Zanieski G, Fahoum B, Tortólani A J. Acute arterial occlusion after ultrasound-guided thrombin injection of a common femoral artery pseudoaneurysm with a wide, short neck.  Ann Vasc Surg. 2008;  22 (3) 473-475
• 9 Pezzullo J A, Dupuy D E, Cronan J J. Percutaneous injection of thrombin for the treatment of pseudoaneurysms after catheterization: an alternative to sonographically guided compression.  AJR. 2000;  175 1035-1040
• 10 Hamraoui K, Ernst S M, van Dessel P F et al. Efficacy and safety of percutaneous treatment of iatrogenic femoral artery pseudoaneurysm by biodegradable collagen injection.  J Am Coll Cardiol. 2002;  39 1297-1304
• 11 O'Sullivan G J, Ray S A, Lewis J S et al. A review of alternative approaches in the management of iatrogenic femoral pseudoaneurysms.  Ann R Coll Surg Engl. 1999;  81 226-234
• 12 Lönn L, Olmarker A, Geterud K et al. Treatment of femoral pseudoaneurysms. Percutaneous US-guided thrombin injection versus US-guided compression.  Acta Radiol. 2002;  43 396-400
• 13 Kang S S, Labropoulos N, Mansour M A et al. Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms.  J Vasc Surg. 2000;  31 289-298
• 14 Ramsay D W, Marshall M. Treatment of iatrogenic femoral artery false aneurysms with ultrasound-guided thrombin injection.  Australas Radiol. 2002;  46 264-266
• 15 Etemad-Rezai R, Peck D J. Ultrasound-guided thrombin injection of femoral artery pseudoaneurysms.  Can Assoc Radiol J. 2003;  54 118-120
• 16 Sheiman R G, Mastromatteo M. Iatrogenic femoral pseudoaneurysms that are unresponsive to percutaneous thrombin injection: potential causes.  AJR Am J Roentgenol. 2003;  181 1301-1304
• 17 Khoury M, Rebecca A, Greene K et al. Duplex scanning-guided thrombin injection for the treatment of iatrogenic pseudoaneurysms.  J Vasc Surg. 2002;  35 517-521
• 18 Reeder S B, Widlus D M, Lazinger M. Low-dose thrombin injection to treat iatrogenic femoral artery pseudoaneurysms.  AJR Am J Roentgenol. 2001;  177 595-598
• 19 Kruger K, Zahringer M, Sohngen F D et al. Femoral pseudoaneurysms: management with percutaneous thrombin injections–success rates and effects on systemic coagulation.  Radiology. 2003;  226 452-458