AJR
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Paulson, E. K.
Right arrow Articles by Kliewer, M. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Paulson, E. K.
Right arrow Articles by Kliewer, M. A.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Hotlight (NEW!)
Right arrow
What's Hotlight?

Sonographically Guided Thrombin Injection of latrogenic Femoral Pseudoaneurysms

Further Experience of a Single Institution

Erik K. Paulson1, Rendon C. Nelson1, Charles E. Mayes2, Douglas H. Sheafor1, Michael H. Sketch, Jr.2 and Mark A. Kliewer1

1 Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
2 Department of Cardiology, Duke University Medical Center, Durham, NC.



View larger version (114K):

[in a new window]
  		Fig. 1. —Drawing illustrates percutaneous injection of thrombin directly into pseudoaneurysm lumen. Using attachable biopsy guide, 22-gauge spinal needle is advanced into lumen, carefully avoiding pseudoaneurysm neck and underlying artery. Once needle is in position, thrombin is slowly injected. Flow in lumen is monitored with color or power Doppler sonography. Formation of thrombus generally occurs within seconds. (Reprinted with permission from [22])

 


View larger version (148K):

[in a new window]
  		Fig. 2A. —65-year-old woman with pulsatile groin mass identified 2 days after coronary angioplasty. Transverse color Doppler sonogram at groin puncture site shows 1.5 x 2.2 cm pseudoaneurysm. Pseudoaneurysm neck and femoral artery are not shown on this image.

 


View larger version (157K):

[in a new window]
  		Fig. 2B. —65-year-old woman with pulsatile groin mass identified 2 days after coronary angioplasty. Using gray-scale sonographic technique, 22-gauge needle is passed into lumen. Note echogenic needle tip (arrow). Particular care is taken to avoid underlying artery and pseudoaneurysm neck.

 


View larger version (161K):

[in a new window]
  		Fig. 2C. —65-year-old woman with pulsatile groin mass identified 2 days after coronary angioplasty. Transverse color Doppler sonogram obtained 12 sec after injection of 650 U of thrombin shows complete thrombosis of lumen. Echogenic material (arrows) represents fresh thrombus.

 


View larger version (75K):

[in a new window]
  		Fig. 3. —66-year-old woman with persistent pseudoaneurysm flow after injection of 300 U of thrombin. Power Doppler sonogram shows thin crescent of flow (arrow) about peripheral aspect of partially thrombosed pseudoaneurysm (arrowheads). Sonographically guided compression was performed for 1 min and resulted in complete thrombosis. Second injection of thrombin was not performed. Follow-up color Doppler sonogram (not shown) showed complete pseudoaneurysm thrombosis.

 


View larger version (82K):

[in a new window]
  		Fig. 4A. —80-year-old man with groin pseudoaneurysm after coronary angioplasty. Transverse color Doppler sonogram shows 3 x 3 cm pseudoaneurysm. Two white lines (arrows) represent anticipated path of needle (using attachable biopsy guide).

 


View larger version (54K):

[in a new window]
  		Fig. 4B. —80-year-old man with groin pseudoaneurysm after coronary angioplasty. Transverse color Doppler sonogram obtained immediately after injection of 600 U of thrombin shows that pseudoaneurysm thrombosed completely. However, persistent flow was identified in pseudoaneurysm neck (arrow). This persistent flow was not treated with second injection of thrombin.

 


View larger version (66K):

[in a new window]
  		Fig. 4C. —80-year-old man with groin pseudoaneurysm after coronary angioplasty. Transverse color Doppler sonogram of groin obtained 1 day after thrombin injection shows thrombosis of pseudoaneurysm neck (arrow).

 


View larger version (155K):

[in a new window]
  		Fig. 5A. —72-year-old woman with pulsatile mass at right groin puncture site. Color Doppler sonogram shows right groin pseudoaneurysm that was subsequently successfully treated with 100 U of thrombin. Two white lines represent anticipated path of needle.

 


View larger version (108K):

[in a new window]
  		Fig. 5B. —72-year-old woman with pulsatile mass at right groin puncture site. Color Doppler sonogram obtained after patient returned to clinic 7 days later with pain, erythema, and tenderness at puncture site shows fluid collection (arrows) at site of treated pseudoaneurysm. Subsequent incision and drainage revealed purulent material containing Staphylococcus aureus.

 

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2001 by the American Roentgen Ray Society.