Dimitri Alejandro Parra MD, Presenter: Nothing to Disclose

Joao Guilherme Amaral MD, Abstract Co-Author: Nothing to Disclose

Philip John MBChB, FRCR, Abstract Co-Author: Nothing to Disclose

Michael John Temple MD, Abstract Co-Author: Nothing to Disclose

Bairbre Louise Connolly MD, Abstract Co-Author: Nothing to Disclose

Peuodaneurysms (PSAs) develop from a disruption of the arterial wall, secondary to a variety of etiologies ( including inflammation, trauma, iatrogenic). It is accepted that image-guided occlusion methods have replaced surgery as the first choice of treatment. The purpose of this presentation is to describe our experience treating femoral artery PSAs with ultrasound (US) guided thrombin injections in pediatric patients.

Between January 2001 and December 2010, 9 PSAs were treated with a thrombin injection in 8 patients (4 girls, 4 boys; mean age 6.9 years). All were diagnosed by US, 6 were secondary to cardiology interventions, 2 post diagnostic IR angiograms and 1 post renal angioplasty. The thrombin injections were performed using deep sedation or general anesthesia, under sterile conditions and US guidance. Follow up was performed with serial USs.

A total of 12 US guided thrombin injections were performed. The mean maximum diameter of the PSAs was 2.5 cm (2.0-4.0 cm). The median dose of thrombin used was 62 U (Mean: 222 U) injected using a 23, 25 or 27 gauge needle. 7/9 PSAs were successfully occluded after one injection, 1/9 required 3 injections to occlude, and 1/9 failed despite 3 injections and required surgery (patient with arterial wall pathology and coagulopathy). No complications were encountered.

In our experience, US guided thrombin injection is a safe and effective therapeutic option for femoral PSAs in pediatric patients, but may require more than one procedure.

US guided thrombin injection is a safe and effective therapeutic option for femoral PSAs in pediatric patients.

Parra, D, Amaral, J, John, P, Temple, M, Connolly, B, Ultrasound-guided Thrombin Injection in Femoral Pseudoaneurysms in Pediatric Patients.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034200.html