Autologous thrombin-induced thrombosis of pseudoaneurysms

Abstract Background This study was designed to evaluate the use of autologous thrombin (as opposed to commercial bovine thrombin) in the percutaneous obliteration of postcatheterization femoral pseudoaneurysms. Methods Ten consecutive patients with a symptomatic femoral pseudoaneurysm following cardiac catheterization underwent duplex assessment. All ten pseudoaneurysms were at least 2 cm in the longest axis. Autologous thrombin was isolated from 60 ml blood, under sterile conditions. The autologous thrombin was injected into the cavity of the pseudoaneurysm under ultrasonographic guidance. The progression of thrombosis was monitored throughout with ultrasonography. After the procedure, the femoral arteries were examined for thrombosis propagation or embolization. The foot pulses and ankle pressures were checked. Samples of the thrombin isolates were analysed to quantify thrombin activity. Duplex assessment was repeated at 6 weeks. Results All ten patients had successful thrombosis of the pseudoaneurysm, although three required repeat thrombin injections within 24 h. No long-term symptoms were identified relating to the thrombosis and no patient required surgery. There was no evidence of recanalization at 6 weeks on duplex imaging, and no signs of infection. Conclusion Autologous thrombin-induced thrombosis of pseudoaneurysms is a simple, safe, painless and inexpensive procedure. This novel approach, which uses the patient's own thrombin, is cheaper than bovine thrombin; it also avoids the risk of viral contamination or anaphylaxis from commercial thrombin.