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Vol 6, No 1 (2004)
Published online: 2004-03-16
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Thrombin injection in obliteration of femoral false aneurysms - own experience

Tomasz Orawczyk, Tomasz Urbanek, Grzegorz Biolik, Damian Ziaja, Krzysztof Szaniewski, Wacław Kuczmik, Marek Kazibudzki
Chirurgia Polska 2004;6(1):7-18.

open access

Vol 6, No 1 (2004)
Published online: 2004-03-16

Abstract

Background: In the last decade an increased number of false aneurysms (FA) of arteries in the sequence of catheterization of peripheral blood vessels have been noted. There are a few methods of treatment - one of them is an injection of thrombin solution to the lumen of a blood vessel, which results in coagulation.
The aim of this work is to evaluate the efficacy, safety and comfort of patients during obliteration treatment, including various concentrations and doses of thrombin, as well as an attempt to find factors that may influence the above mentioned factors.
Material and methods: In the period from September 2002 to December 2003, there were 40 patients with false aneurysms of the femoral artery treated with the obliteration method. After a preparatory estimation of the patient’s clinical data and FA parameters, an ultrasound-guided thrombin injection with a concentration of 400 U/ml (group A - 20 patients) and of 200 U/ml (group B - 20 patients) was performed (thrombin was injected with 12 G needle whose tip was put to the centre of the false aneurysm).
Results: The total effectiveness of the thrombin injection was 100%. FA thrombosis of once injected dose of thrombin was achieved in 37 patients (92.5%). In 3 patients (3 of group A patients, 0 of B group, p < 0.0001) it was necessary to administer thrombin once again. The time which had passed from the endovascular procedure to the obliteration treatment, as well as the diameter of the neck of FA had a considerable influence on the repeated administration of thrombin, however, the mode of endovascular procedure, treatment with anticoagulants and the possibility of the pressure on the neck of FA had no influence. On average, 0.76 (0.2–2.4) ml of thrombin in group A, 104 (40–400) in group B of thrombin units were injected. A high correlation between the doses of thrombin and the flow volume in TR (R2 p = 0.51, p < 0.0000001), moderate correlation between volume of administered thrombin and the number of chambers TR (R2 p = 0.22, p < 0.001) as well as a poor correlation between the volumes of administered thrombin and the width of the neck of FA (R2 p = 0.14, p = 0.02) was shown. There was no revealed correlation between the volumes of injected thrombin and the length of FA neck (R2 p = 0.01, p = 0.48). In the analyzed patients, after the obliteration treatment, a reduction of pain, improved sleep, better motor activity and general feeling were obtained; there were no statistically significant differences between groups A and B. During hospitalization, there was 7 cases of complications altogether - 5 in group A (3 cases of post-embolization syndrome and 2 of transient peripheral ischemia of lower extremity) and 2 in group B (one case of abscess in the puncture place and one post-embolization syndrome). No correlation was shown between the complications after thrombin treatment and the concentration of injected thrombin. The average time of hospitalization in the examined group was 2.3 (2–8) days - 2.6 (2–8) in group A and 2 days in group B (no statistical significance). The calculated average cost of treatment of FA with thrombin was 400 PLN. In group A, the average cost of treatment was 450 PLN, and was 100 PLN higher than in group B.
Conclusions: 1. Thrombin injection should be considered as the method of choice in FA treatment. 2. This method has a high therapeutic effectiveness (even in patients who received anticoagulant therapy), it is safe (even in patients with a high rate of complications risk), simple, quick and does not require long hospitalization time. 3. The use of low-concentration thrombin enables the lowering of the costs of treatment while simultaneously keeping the same effectiveness, safety and comfort of the patient like during treatment with higher concentrations.

Abstract

Background: In the last decade an increased number of false aneurysms (FA) of arteries in the sequence of catheterization of peripheral blood vessels have been noted. There are a few methods of treatment - one of them is an injection of thrombin solution to the lumen of a blood vessel, which results in coagulation.
The aim of this work is to evaluate the efficacy, safety and comfort of patients during obliteration treatment, including various concentrations and doses of thrombin, as well as an attempt to find factors that may influence the above mentioned factors.
Material and methods: In the period from September 2002 to December 2003, there were 40 patients with false aneurysms of the femoral artery treated with the obliteration method. After a preparatory estimation of the patient’s clinical data and FA parameters, an ultrasound-guided thrombin injection with a concentration of 400 U/ml (group A - 20 patients) and of 200 U/ml (group B - 20 patients) was performed (thrombin was injected with 12 G needle whose tip was put to the centre of the false aneurysm).
Results: The total effectiveness of the thrombin injection was 100%. FA thrombosis of once injected dose of thrombin was achieved in 37 patients (92.5%). In 3 patients (3 of group A patients, 0 of B group, p < 0.0001) it was necessary to administer thrombin once again. The time which had passed from the endovascular procedure to the obliteration treatment, as well as the diameter of the neck of FA had a considerable influence on the repeated administration of thrombin, however, the mode of endovascular procedure, treatment with anticoagulants and the possibility of the pressure on the neck of FA had no influence. On average, 0.76 (0.2–2.4) ml of thrombin in group A, 104 (40–400) in group B of thrombin units were injected. A high correlation between the doses of thrombin and the flow volume in TR (R2 p = 0.51, p < 0.0000001), moderate correlation between volume of administered thrombin and the number of chambers TR (R2 p = 0.22, p < 0.001) as well as a poor correlation between the volumes of administered thrombin and the width of the neck of FA (R2 p = 0.14, p = 0.02) was shown. There was no revealed correlation between the volumes of injected thrombin and the length of FA neck (R2 p = 0.01, p = 0.48). In the analyzed patients, after the obliteration treatment, a reduction of pain, improved sleep, better motor activity and general feeling were obtained; there were no statistically significant differences between groups A and B. During hospitalization, there was 7 cases of complications altogether - 5 in group A (3 cases of post-embolization syndrome and 2 of transient peripheral ischemia of lower extremity) and 2 in group B (one case of abscess in the puncture place and one post-embolization syndrome). No correlation was shown between the complications after thrombin treatment and the concentration of injected thrombin. The average time of hospitalization in the examined group was 2.3 (2–8) days - 2.6 (2–8) in group A and 2 days in group B (no statistical significance). The calculated average cost of treatment of FA with thrombin was 400 PLN. In group A, the average cost of treatment was 450 PLN, and was 100 PLN higher than in group B.
Conclusions: 1. Thrombin injection should be considered as the method of choice in FA treatment. 2. This method has a high therapeutic effectiveness (even in patients who received anticoagulant therapy), it is safe (even in patients with a high rate of complications risk), simple, quick and does not require long hospitalization time. 3. The use of low-concentration thrombin enables the lowering of the costs of treatment while simultaneously keeping the same effectiveness, safety and comfort of the patient like during treatment with higher concentrations.
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Keywords

iatrogenic false aneurysm; thrombin injection; endovascular procedures

About this article
Title

Thrombin injection in obliteration of femoral false aneurysms - own experience

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 6, No 1 (2004)

Pages

7-18

Published online

2004-03-16

Bibliographic record

Chirurgia Polska 2004;6(1):7-18.

Keywords

iatrogenic false aneurysm
thrombin injection
endovascular procedures

Authors

Tomasz Orawczyk
Tomasz Urbanek
Grzegorz Biolik
Damian Ziaja
Krzysztof Szaniewski
Wacław Kuczmik
Marek Kazibudzki

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