Ultrasound-Guided Thrombin Injection in the Treatment of Femoral Artery Pseudoaneurysm after Percutaneous Procedures in Patients with Acute Coronary Syndrome

background: Ultrasound-guided thrombin injection (TI) is an option for the treatment of femoral artery pseudoaneurysm. Nevertheless, the result of this technique in patients with acute coronary syndrome (ACS) may be compromised by the use of antithrombotic drugs. In addition, thrombin extravasation to systemic circulation could potentially cause an increase in thromboembolic events. Methods: Patients admitted with ACS who developed femoral artery pseudoaneurysm after a percutaneous procedure and treated by TI between January 2007 and July 2011 were included. Clinical and laboratory characteristics, treatment results and complications were evaluated. results: We evaluated 23 patients with mean age of 67.1 ± 14.2 years, 60.9% were women, with body mass index of 28.4 ± 4.7 kg/m2 and 52.2% were diabetics. At presentation, 87% had non-ST elevation ACS and the remaining had ST elevation myocardial infarction. Of the evaluated patients, 70% were submitted to percutaneous coronary intervention. All patients were receiving aspirin, 78.3% used P2Y12 inhibitors and 39.1% used glycoprotein IIb/IIIa inhibitors. TI was successful in occluding the pseudoaneurysm in 100% of cases (96.7% after the first injection), without distal embolization, local infection or need of surgical correction. There were no cases of myocardial infarction, stroke or unscheduled revascularization. There was one death due to cardiogenic shock 1 Resident physician at the Invasive Cardiology Service of Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil. 2 Resident physician at the Invasive Cardiology Service of Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil. 3 Resident physician at the Invasive Cardiology Service of Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil. 4 Doctor. Cardiologist physician at the Invasive Cardiology Service of Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil. 5 Doctor. Cardiologist physician at the Invasive Cardiology Service of Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil. 6 Full professor. Interventionist cardiologista physician at the Invasive Cardiology Service of Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil. 7 Full professor. Interventionist Cardiologist at the Invasive Cardiology Service of Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil. 8 Interventionist cardiologist physician at the Invasive Cardiology Service of Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil. 9 Full professor. Director of Invasive Cardiology Service of Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil. Correspondence to: Fábio Augusto Pinton. Av. Dr. Enéas Carvalho de Aguiar, 44 – Cerqueira César – São Paulo, SP, Brazil – CEP 05403-900 E-mail: [email protected] Received on: 2/1/2013 • Accepted on: 28/2/2013 Original Article