Ultrasound‐guided percutaneous thrombin injection for the management of upper extremity pseudoaneurysms: 20 years of tertiary care center experience

Abstract

PurposeTo evaluate the safety and efficacy of ultrasound‐guided percutaneous thrombin injection for the treatment of upper extremity pseudoaneurysms.MethodsAn institutional database containing 8,316,467 radiology reports was searched for suitable cases over a 241‐month period. Fourteen female and 10 male patients, average age of 69.7 years (range 29–93) underwent a total of 26 procedures for the management of upper extremity pseudoaneurysms, involving the radial (n = 9), brachial (n = 9) or other upper extremity arteries (n = 6). Baseline demographic and pseudoaneurysm characteristics were documented, together with primary and secondary success, failures, and complications. All procedures were performed with real‐time ultrasound guidance.ResultsThe mean pseudoaneurysm volume was 9.93 cm3 (range 0.06–111.62 cm3). Twelve cases were related to central line placement or arterial access. Primary success was obtained in 50% (n = 12) after a single ultrasound‐guided thrombin injection, and secondary success was achieved in an additional six (for a total success of 75%). Success was highest for the treatment of brachial artery pseudoaneurysms (87.5%), and in those who were diagnosed within 7 days of the inciting event, findings that were statistically significant (p‐value 0.046 and 0.002, respectively).ConclusionsUltrasound‐guided percutaneous thrombin injection is safe and effective for managing upper extremity pseudoaneurysms.