Comparisons on the therapeutic efficacy for upper limb pseudoaneurysm by ultrasound guided thrombin injection and ultrasound guided compression repair / 解放军医学杂志

ABSTRACT

Objective To compare the therapeutic efficacy and safety of ultrasound-guided thrombin injection (UGTI) combined with saline injection and ultrasound-guided compression repair (UGCR) for upper limb pseudoaneurysm (PSA). Methods The clinical features and therapeutic efficacy of UGCR and UGTI for PSA of the upper extremities were retrospectively assessed after catheterization through radial artery. When UGCR was conducted, PSA, its communicating emissaries with other arteries were first identified with color Doppler, and then direct manual compression over the aneurysm for 30 minutes until complete thrombosis was observed. When UGCR failed, a 20-22G needle was inserted into PSA and saline was injected with continuous color Doppler guidance to confirm that the tip of the needle was in the aneurysm. Then thrombin was injected into the aneurysmal sac. All the patients were followed-up clinically and with ultrasound 24h or 14-30 days after the treatments. Results For the 14 patients with upper limb PSA who received UGCR for the first time, 5 were cured with a success rate of 35.7%. Nine cases underwent repeated UGCR treatment, and it was successful in four patients. The overall success rate for UGCR was 64.3% (9/14). All the five patients in whom UGCR failed were successfully cured when UGTI was conducted. In four cases it was successful after the first UGTI, and only one patient received repeated UGTI treatment. The total success rate for UGTI was 100% (5/5). No obvious adverse effect and recurrence were found after follow-up for 14-30 days in all patients. Conclusions Both UGCR and UGTI are safe, effective, and expedient treatment for patients with PSA in the upper extremity. UGTI is the preferred method for its simplicity, high success rate and avoidance of possible distal arterial embolism.