Behandlung des persistierenden Aneurysma spurium aus gefäß chirurgischer perspektive: Ultraschallgesteuerte thrombininjektion oder operative versorgung?

Purpose. This retrospective study evaluated experiences with ultrasound-guided thrombin injection and open surgical repair for the treatment of arterial pseudoaneurysms.Method. Between January 2006 and December 2010, 51 patients (26 male, 25 female, mean age 70.5±11.9 years) were treated for pseudoaneurysms of the femoral artery.Results. Out of 51 patients 33 underwent surgical repair of pseudoaneurysms, 18 were treated by ultrasound-guided percutaneous thrombin injection and 48 (94.1%) patients received anticoagulation therapy (36 patients with platelet inhibitors, 6 patients with anticoagulation, such as cumarine and 6 patients with low molecular weight heparin). One patient suffered from mild hemophilia A. The mean operation time was 58.6±36.4 min and mean postoperative hospital stay was 9.8±6.3 days. Major complications (defined as needed surgical revision) occurred in three patients of the surgical group (9.1%) and two patients of the thrombin group (11.1%). Indications of surgical revision included postoperative hematoma (n=3), unsuccessful thrombin injection (n=1) and compression of the femoral vein (n=1). Minor complications were only observed in nine patients in the surgical group (27.3%), two patients developed postoperative pneumonia and seven patients had wound healing disorders. No mortalities were observed in either group.Conclusions. The endovascular orientation and interdisciplinary assignment of vascular surgery have created a new perception for the treatment of arterial pseudoaneurysms. Ultrasound-guided thrombin injection is considered to be a safe alternative to surgical intervention for selected patients.