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Innere Medizin 24. Juni 2016

Percutaneous instillation of physiological saline solution for the treatment of femoral pseudoaneuryms

Objective: To investigate the efficacy of para-aneurysmal saline injection for closure of postcatheterization pseudo-aneurysm (PA) at the vascular access site.

Methods: Fifty-one consecutive patients with postcatheterization PA at the vascular access site were included to undergo percutaneous para-aneurysmal saline injection. In case of technical failure the day after, PA were treated by bovine thrombin injection. Anatomical properties of the PA were recorded as were details to injection.

Results: Initially all patients exhibited success which was reduced to 43 % at day one. A saline volume of median 7 ml (interquartile range 6–8 ml) has been injected. The amount of injected saline was not different in patients with and without treatment success at day one (P = 0.6). Several anatomical properties of the PA exhibited marked differences in patients with or without success. The length (10.3 mm (7.8–12.0) vs. 12.5 mm (10.3–15.0); P = 0.009) and the angulation (110° (100–118) vs. 140° (129–146); P < 0.001) of the fistula/vessel axis was statistically different between groups. The peak systolic velocity failed to show significance with a tendency to higher values in the ineffective study group (P = 0.07). No peripheral complications occurred.

Conclusion: Para-aneurysmal saline injection may be a therapeutic alternative to percutaneous thrombin injection in patients exhibiting favorable anatomical properties.

Georgiana-Aura Giurgea, Irene Mlekusch, Matthias Hoke, Alexandra Carls, Schila Sabeti-Sandor, Erich Minar, Prof. Dr. Wolfgang Mlekusch, Wiener klinische Wochenschrift 11/12/2016

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