Management of complex two-chamber false aneurysms by thrombin injections in patients under clopidogrel, aspirin or both

Abstract

Present management of false aneurysms consist of surgical repair or compression therapy. The main drawbacks of surgery are its invasiveness and the increase of hospitalization time and costs, that of compression therapy pain and prolonged compression bandages. An alternative to both is selective injection of thrombin. Aim of the present study was to addresses the efficacy and safety of thrombin injections into two chamber false aneurysms. The patients were examined with color Doppler ultrasound (7.5 MHz transducer). A complex aneurysm was defined as an aneurysm with at least two chambers. Ten patients had two-chamber false aneurysms. Mean age was 75.7 years. All patients had received ASS, clopidogrel (n = 6), or enoxaparin (n = 9; 0.4 to 1.0 mg b.i.d.), and one patient had received i.v. heparin (1000 U/h). Thrombin (GenTrac, USA) was injected under ultrasound guidance. Between 500–2000 U of thrombin resulted in immediate thromboses of both chambers of the aneurysm in eight patients (80%). In one patient, the second chamber was successfully treated by a second thrombin after 24 hours. Another patient required compression therapy for the second chamber. One patient had a re-occurrence of flow within one chamber of his complex aneurysm the day after the initial treatment. This patient was successfully managed by a second thrombin injection. No patient underwent surgery, and no complications occurred until hospital discharge. Injection of thrombin even into complex, two chamber false aneurysms is a highly successful and safe treatment, no matter what the state of anticoagulation and anti-aggregation therapy is.