Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000100006
Jornal Vascular Brasileiro
Original Article

Experiência inicial com o uso de adesivo tissular contendo trombina para tratamento do pseudo-aneurisma femoral

Treatment of femoral pseudoaneurysm with thrombin tissue adhesive: initial experience

Daniel Mendes Pinto; José Olimpio Dias Júnior; Bernardo Lopes Cançado Fonseca; Rodrigo Daniel Moreialvar; Leonardo Ghizoni Bez; Caetano de Sousa Lopes

http://dx.doi.org/10.1590/S1677-54492006000100006 J Vasc Bras, vol.5, n1, p.30-36, 2006
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Resumo

O pseudo-aneurisma (PSA) após cateterização femoral tem sido diagnosticado com regularidade em serviços com grande movimento de intervenções percutâneas, com incidência variando de 0,05 a 6%. PSA femorais pequenos podem ser acompanhados até a resolução espontânea. As opções de tratamento são: compressão guiada por ultra-som, injeção de trombina para trombose do PSA e tratamento cirúrgico. A injeção percutânea de trombina tem a vantagem de ser um procedimento indolor e rápido. Podem ser utilizados trombina isolada ou preparados contendo trombina associada a fibrinogênio e fatores de coagulação. A experiência inicial dos autores de cinco casos tratados com injeção de adesivo tissular contendo trombina mostrou resultado satisfatório em quatro; um caso necessitou tratamento cirúrgico. Não houve sucesso com uso isolado de trombina humana, porém, ocorreu trombose imediata após injeção de preparado de trombina associada a fibrinogênio/fator XIII. Neste artigo, são discutidas as opções de tratamento dos PSA femorais e a técnica do uso de trombina percutânea.

Palavras-chave

Pseudo-aneurisma, ultra-som, trombina, fibrinogênio

Abstract

Pseudoaneurysms caused by femoral artery catheterization have been regularly diagnosed in medical units with a great number of percutaneous interventions, with a documented incidence between 0.05 and 6%. Small femoral pseudoaneurysms undergo spontaneous resolution. Treatment options are: ultrasound-guided compression, thrombin injection to induce pseudoaneurysm thrombosis and surgical treatment. Percutaneous thrombin injection has the advantage of being a fast and painless procedure. Both isolated thrombin and thrombin preparations with fibrinogen and coagulation factors can be used. The authors' initial experience with five cases treated with thrombin tissue adhesive showed successful results in four; one case required surgery. There was no success with isolated human thrombin, but immediate thrombosis was achieved after injection of thrombin associated to fibrinogen and factor XIII. In this article, the treatment options for femoral pseudoaneurysms and the technique of percutaneous thrombin are discussed.

Keywords

Pseudoaneurysm, ultrasonography, thrombin, fibrinogen

References

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

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

Hye RJ. Compression therapy for acute iatrogenic femoral pseudoaneurysms. Semin Vasc Surg. 2000;13:58-61.

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

Tamin WZ, Arbid EJ, Andrews LS, Arous EJ. Percutaneous induced thrombosis of iatrogenic femoral pseudoaneurysms following catheterization. Ann Vasc Surg. 2000;14:254-9.

Kang SS, Lapropoulos N, Mansour MA. Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms. J Vasc Surg. 2000;31:289-98.

Gale SS, Scissons RP, Jones L, Salles-Cunha SX. Femoral pseudoaneurysm thrombinjection. Am J Surg.. 2001;181:379-83.

Knight CG, Healy DA, Thomas RL. Femoral artery pseudoaneurysms: risk factors, prevalence and treatment options. Ann Vasc Surg. 2003;17:503-8.

Middleton WD, Dasyam A, Teefey SA. Diagnosis and treatment of iatrogenic femoral artery pseudoaneurysms. Ultrasound Q. 2005;21:3-17.

Demirbas O, Batyraliev T, Eksi Z, Pershukov I. Femoral pseudoaneurysm due to diagnostic or interventional angiographic procedures. Angiology. 2005;56:553-6.

Olsen DM, Rodriguez JA, Vranic M, Ramaiah V, Ravi R, Diethrich EB. A prospective study of ultrasound scan-guided thrombin injection of femoral pseudoaneurysm: a trend toward minimal medication. J Vasc Surg. 2002;36:779-82.

Fellmeth BD, Roberts AC, Bookstein JJ. Postangiographic femoral artery injuries: non-surgical repair with ultrasound guided compression. Radiology. 1991;178:671-5.

Lonn L, Olmarker A, Geterud K, Risberg B. Prospective randomized study comparing ultrasound-guided thrombin injection to compression in the treatment of femoral pseudoaneurysms. J Endovasc Ther. 2004;11:570-6.

Danzi GB, Sesana M, Capuano C. Compression repair versus low-dose thrombin injection for the treatment of iatrogenic femoral pseudoaneurysm: a retrospective case-control study. Ital Heart J. 2005;6:384-9.

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

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

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.

Kruger K, Zaehringer M, Sohngen FD. Femoral pseudoaneurysms: management with percutaneous thrombin injections - success rates and effects on systemic coagulation. Radiology. 2003;226:452-8.

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

Friedman SG, Pellerito JS, Scher L, Faust G, Burke B, Safa T. Ultrasound-guided thrombin injection is the treatment of choice for femoral pseudoaneurysms. Arch Surg. 2002;137:462-4.

Loose HW, Haslam PJ. The management of peripheral arterial aneurysms using percutaneous injection of fibrin adhesive. Br J Radiol. 1998;71:1255-9.

Matson MB, Morgan RA, Belli AM. Percutaneous treatment of pseudoaneurysms using fibrin adhesive. Br J Radiol. 2001;74:690-4.

Walker TG, Geller SC, Brewster DC. Transcatheter occlusion of a profunda femoral artery pseudoaneurysm using thrombin. AJR Am J Roentgenol. 1987;149:185-6.

Engelke C, Quarmby J, Ubhayakar G, Morgan R, Holmes K, Belli AM. Autologous thrombin: a new embolization treatment for traumatic intrasplenic pseudoaneurysm. J Endovasc Ther. 2002;9:29-35.

Aytekin C, Firat A, Yildirim E, Kirbas I, Boyvat F. Ultrasound-guided glue injection as alternative treatment of femoral pseudoaneurysms. Cardiovasc Intervent Radiol. 2004;27:612-5.

Kurz DJ, Jungius KP, Luscher TF. Delayed femoral vein thrombosis after ultrasound-guided thrombin injection of a postcatheterization pseudoaneurysm. J Vasc Interv Radiol. 2003;14:1067-70.

Paulson EK, Nelson RC, Mayes CE, Sheafor DH, Sketch MH Jr, Kliewer MA. Sonographically guided thrombin injection of iatrogenic femoral pseudoaneurysms: further experience of a single institution. AJR Am J Roentgenol. 2001;177:309-16.

Sackett WR, Taylor SM, Coffey CB. Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms: a prospective analysis. Am Surg. 2000;66:937-40.

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

Vazquez V, Reus M, Pinero A. Human thrombin for treatment of pseudoaneurysms: comparison of bovine and human thrombin sonogram-guided injection. AJR Am J Roentgenol. 2005;184:1665-71.

Pope M, Johnston KW. Anaphylaxis after thrombin injection of a femoral pseudoaneurysm: recommendations for prevention. J Vasc Surg. 2000;32:190-1.

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