Comparison of the Clinical Efficacy of Bovine Thrombin and Compression Method in Femoral Pseudo Aneurysm of Patients Undergoing per Coetaneous Coronary Intervention at Shaheed Rajaie Cardiovascular Medical and Research Center

Pseudo aneurysm has been an increasingly common complication of catheterization procedures during the past two decades, with the greatest incidence being in the femoral artery. Treatment of the iatrogenic femoral artery pseudo aneurysm with the injection of thrombin is reported to be an efficacious and safe procedure. In this study, we evaluated the efficacy and success rate of per coetaneous ultrasonographically-guided thrombin injection and compression method for the treatment of pseudo aneurysm and to determine the effect of thrombin injection on systemic coagulation parameters. This Cohort clinical trial was conducted on patients with femoral pseudo aneurysm after percutaneous intervention (PCI) in Shaheed Rajaie Cardiovascular Medical and Research Center. The patients were divided into two randomized groups and treated with either the compression method or the percutaneous ultrasonographic-guided thrombin injection method. Pseudo aneurysm size, pseudo aneurysms neck size, thrombin dose, thrombosis time, outcome of therapy, and complications were documented prospectively. Duplex sonographic follow-up examinations were performed at 0 and 24 hours afterwards. Partial thrombin time as well as the Quick test (pro thrombin time) was monitored before and after the intervention. Thirty patients with femoral pseudoaneurysm following catheterization between 15 and 85 years of age were enrolled in this study. The mean size of the pseudo aneurysms length was 2.45 ± 1.15cm (SD) and pseudo aneurysms width was 2.06 ± 1.07cm. In total, 13 thrombin injections were administered. The mean thrombin dose was 500-2000 IU. The success rate of thrombin injection was %92.30 (12 of 13 patients), which was significantly higher than 82.35% (13 of 17 patients) in the compression method (p value<0.05). No thrombo embolic, infectious, or allergic complications occurred. In this study, the percutaneous ultrasonographically-guided thrombin injection method was successful and safe in the management of femoral pseudoaneurysms. Changes in coagulating factors indicated the possibility of thrombin passage into the arterial circulation.