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Endoscopic ultrasound-guided thrombin injection, a management approach for visceral artery pseudoaneurysms
submitted 20 August 2019
accepted after revision 28 October 2019
21 February 2020 (online)
Background and study aims Pseudoaneurysms are usually associated with high rates of morbidity and mortality. There are limited data in the literature on endoscopic ultrasound (EUS)-guided thrombin injection for pseudoaneurysms. The aim of this study is to assess the efficacy and safety of EUS-guided thrombin injection for pseudoaneurysms.
Patients and methods This prospective study was conducted in our department between January and December 2018. All patients with symptomatic visceral artery pseudoaneurysms, who were unable to undergo angioembolization, were enrolled consecutively. Data related to demography, laboratory parameters, radiological imaging, pseudoaneurysms, and endotherapy were analyzed.
Results Eight patients with median age 34 years (27–58 years), all men, were studied. The vessel involved was the splenic artery in 5 patients (62.5 %), the left hepatic artery in 2 (25 %), and the gastroduodenal artery in 1 patient (12.5%). The median size of the pseudoaneurysms was 2.9 cm × 2.6 cm (range, 1.8 × 1.9–4 × 5 cm). The median thrombin requirement was 400 IU (range, 200–500 IU) for loss of Doppler flow signals. EUS after 3 months showed obliterated pseudoaneurysms in 7 patients (87.5 %), while recurrence was observed in 1 patient (12.5 %) after 6 weeks.
Conclusions EUS-guided thrombin injection may be a new option for the management of pseudoaneurysms.
- 1 Huiziga WK, Baker LW. Surgical intervention for regional complications of chronic pancreatitis. Int Surg 1993; 78: 315-319
- 2 Gambiez LP, Ernst OJ, Merlier OA. et al. Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis. Arch Surg 1997; 132: 1016-1021
- 3 Gamangatti S, Thingujam V, Garg P. et al. Endoscopic ultrasound guided thrombin injection of angiographically occult pancreatitis associated visceral artery pseudoaneurysm: case series. World J Gastrointest Endosc 2015; 7: 1107-1113
- 4 Elford J, Burrell C, Freeman S. et al. Human thrombin injection for the percutaneous treatment of iatrogenic pseudoaneurysms. Cardiovasc Intervent Radiol 2002; 25: 115-118
- 5 Vlachou PA, Karkos CD, Bains S. et al. Percutaneous ultrasound-guided thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms. Eur J Radiol 2011; 77: 172-174
- 6 Jhajharia A, Wanjari S, Ashdhir P. et al. Endoscopic ultrasound-guided thrombin injection for management of visceral artery pseudoaneurysm: A novel approach. Indian J Gastroenterol 2018; 37: 271-275
- 7 Roach H, Roberts SA, Salter R. et al. Endoscopic ultrasound-guided thrombin injection for the treatment of pancreatic pseudoaneurysm. Endoscopy 2005; 37: 876-878
- 8 Robinson M, Richards D, Carr N. Treatment of splenic artery pseudoaneurysm by endoscopic ultrasound-guided thrombin injection. Cardiovasc Intervent Radiol 2007; 30: 515-517
- 9 Lameris R, du Plessis J, Nieuwoudt M. et al. A visceral artery pseudoaneurysm: management by EUS guided-thrombin injection. Gastrointest Endosc 2011; 73: 392-395
- 10 Chaves DM, Costa FF, Matuguma S. et al. Splenic artery pseudoaneurysm treated with thrombin injection guided by endoscopic ultrasound. Endoscopy 2012; 44: E99-E100
- 11 Sharma M, Somani P, Talele R. et al. EUS-guided thrombin injection of cystic artery pseudoaneurysm leading to Mirrizi’s syndrome and hemobilia. Video GIE 2019; 4: 163-165
- 12 Rai P, Mohan S, Sharma M. EUS guided thrombin injection in large splenic artery pseudoaneurysm: first report in a patient with tropical chronic pancreatitis. Endoscopy 2014; 46: E355-E356
- 13 Sharma M, Somani P, Sunkara T. et al. Endoscopic ultrasound-guided coil embolization and thrombin injection of a bleeding gastroduodenal artery pseudoaneurysm. Endoscopy 2019; 51: E36-E37
- 14 Bokun T, Grgurevic I, Kujundzic M. et al. EUS-guided vascular procedures: a literature review. Gastroenterol Res Pract 2013; DOI: 10.1155/2013/865945.
- 15 Cordova AC, Sumpio BE. Visceral artery aneurysm and pseudoaneurysm – Should they all be managed by endovascular technique?. Ann Vasc Dis 2013; 6: 687-693
- 16 Pulli R, Dorigo W, Troisi N. et al. Surgical treatment of visceral artery aneurysms: A 25-year experience. J Vasc Surg 2008; 48: 334-342
- 17 Ferrero E, Viazzo A, Ferri M. et al. Management and urgent repair of ruptured visceral artery aneurysms. Ann Vasc Surg 2011; 25: 981.e7-11
- 18 Etezadi V, Gandhi RT, Benenati JF. et al. Endovascular treatment of visceral and renal artery aneurysms. J Vasc Interv Radiol 2011; 22: 1246-1253
- 19 Ammori BJ, Alexander DJ, Madan M. Haemorrhagic complications of pancreatitis: presentation, diagnosis and management. Ann R Coll Surg Eng 1998; 8: 316-325
- 20 Crawley JT, Zanardelli S, Chion CK. et al. The central role of thrombin in hemostasis. J Thromb Haemost 2007; 5: 95-101
- 21 Rai P, Kc H, Goel A. et al. Endoscopic ultrasound-guided coil and glue for treatment of splenic artery pseudo-aneurysm: new kid on the block. Endosc Int Open 2018; 7: E821-E825
- 22 Kurzawski J, Janion-Sadowska A, Sadowski M. A novel minimally invasive method of successful tissue glue injection in patient with iatrogenic pseudoaneurysm. Br J Radiol 2018; 91: 1087
- 23 EI Ford J, Burrell C, Freeman S. et al. Human thrombin injection for the percutaneous treatment of iatrogenic pseudoaneurysms. Cardiovasc Intervent Radiol 2002; 25: 115-118
- 24 Sadiq S, Ibrahim W. Thromboembolism complicating thrombin injection of femoral artery pseudoaneurysm: management with intraarterial thrombolysis. J Vasc Interv Radiol 2001; 12: 633-636