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Meta-Analysis
. 2013 Nov 29;2013(11):CD004981.
doi: 10.1002/14651858.CD004981.pub4.

Treatment for femoral pseudoaneurysms

Paul V Tisi, Michael J Callam
Meta-Analysis

Treatment for femoral pseudoaneurysms

Paul V Tisi et al. Cochrane Database Syst Rev. .

Abstract

Background: Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, but sometimes definitive treatment is needed. Surgery has traditionally been considered the 'gold standard' treatment, although it is not without risk in patients with severe cardiovascular disease. Less invasive treatment options such as Duplex ultrasound-guided compression and percutaneous thrombin injection are available, however, evidence of their efficacy is limited. This is an update of a Cochrane review first published in 2006.

Objectives: To assess the effects of different treatments for femoral pseudoaneurysms resulting from endovascular procedures, specifically assessing less invasive treatment options such as blind manual or mechanical compression, ultrasound-guided compression, or percutaneous thrombin injection.

Search methods: For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2013) and CENTRAL (2013, Issue 9).

Selection criteria: Randomised controlled trials (RCTs) comparing two treatments for femoral pseudoaneurysms following vascular interventional procedures were considered for inclusion in the review.

Data collection and analysis: Four studies were included in the analyses comparing: manual compression versus ultrasound-guided compression; ultrasound-guided application of a mechanical device (FemoStop) versus blind application; and ultrasound-guided compression versus percutaneous thrombin injection (two studies). There were no studies with a surgical intervention arm. Data were extracted independently by both authors.

Main results: Compression (manual or FemoStop) was effective in achieving pseudoaneurysm thrombosis although ultrasound-guided application failed to confer any benefit (risk ratio (RR) 0.96; 95% confidence interval (CI) 0.88 to 1.04).Percutaneous thrombin injection was more effective than a single session of ultrasound-guided compression in achieving primary pseudoaneurysm thrombosis within individual RCTs but merged data failed to show statistical significance (RR 2.81; 95% CI 0.44 to 18.13). There was no statistically significant difference in the length of hospital stay between the two groups and no complications were reported apart from one deep vein thrombosis in the compression group.

Authors' conclusions: The limited evidence base appears to support the use of thrombin injection as an effective treatment for femoral pseudoaneurysm. A pragmatic approach may be to use compression (blind or ultrasound-guided) as first-line treatment, reserving thrombin injection for those in whom the compression procedure fails.

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Conflict of interest statement

None known

Figures

1
1
Study flow diagram.
1.1
1.1. Analysis
Comparison 1 Ultrasound‐guided compression versus blind compression, Outcome 1 Thrombosis of pseudoaneurysm within 24 hours (primary outcome).
1.2
1.2. Analysis
Comparison 1 Ultrasound‐guided compression versus blind compression, Outcome 2 Thrombosis of pseudoaneurysm within 2 days.
1.3
1.3. Analysis
Comparison 1 Ultrasound‐guided compression versus blind compression, Outcome 3 Thrombosis of pseudoaneurysm within 3 days.
1.4
1.4. Analysis
Comparison 1 Ultrasound‐guided compression versus blind compression, Outcome 4 Requirement for analgesia/sedation.
2.1
2.1. Analysis
Comparison 2 Thrombin injection versus ultrasound‐guided compression, Outcome 1 Thrombosis of pseudoaneurysm within 24 hours (primary outcome).
2.2
2.2. Analysis
Comparison 2 Thrombin injection versus ultrasound‐guided compression, Outcome 2 Thrombosis of pseudoaneurysm within 2 days.
2.3
2.3. Analysis
Comparison 2 Thrombin injection versus ultrasound‐guided compression, Outcome 3 Thrombosis of pseudoaneurysm within 3 days (primary outcome).
2.4
2.4. Analysis
Comparison 2 Thrombin injection versus ultrasound‐guided compression, Outcome 4 Thrombosis of pseudoaneurysm within 7 days.
2.5
2.5. Analysis
Comparison 2 Thrombin injection versus ultrasound‐guided compression, Outcome 5 Primary outcome: thrombosis of pseudoaneurysm.
2.6
2.6. Analysis
Comparison 2 Thrombin injection versus ultrasound‐guided compression, Outcome 6 Complication rate.
2.7
2.7. Analysis
Comparison 2 Thrombin injection versus ultrasound‐guided compression, Outcome 7 Length of hospital stay (days).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Chatterjee 1999 {published data only}
    1. Chatterjee T, Do DD, Mahler F, Meier B. A prospective, randomized evaluation of nonsurgical closure of femoral pseudoaneurysm by compression device with or without ultrasound guidance. Catheterization and Cardiovascular Interventions 1999;47(3):304‐9. - PubMed
Liu 2006 {published data only}
    1. Liu Y‐M, Hua Y, Liu Q, Ling C, Duan C. Efficacy comparison of different treatment methods for femoral pseudoaneurysms under ultrasonographic guidance. Chinese Journal of Cerebrovascular Diseases 2006;3(10):433‐6.
Lonn 2004 {published data only}
    1. Lonn L, Olmarker A, Geterud K, Risberg B. Prospective randomized study comparing ultrasound‐guided thrombin injection to compression in the treatment of femoral pseudoaneurysms. Journal of Endovascular Therapy 2004;11:570‐6. - PubMed
Paschalidis 2006 {published data only}
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References to studies excluded from this review

Lewandowski 2011 {published data only}
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    1. Lewandowski P, Wasek W, Maciejewski P, Budaj A. Efficacy and safety of closing postcatheterisation pseudoaneurysms with ultrasound‐guided thrombin injection with two modalities: bolus versus slow injection. A prospective randomized trial. European Heart Journal 2009;30:986. - PubMed
Maca 2003 {published data only}
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References to other published versions of this review

Tisi 2006
    1. Tisi PV, Callam MJ. Surgery versus non‐surgical treatment for femoral pseudoaneurysms. Cochrane Database of Systematic Reviews 2006, Issue 1. [DOI: 10.1002/14651858.CD004981.pub2] - DOI - PubMed
Tisi 2009
    1. Tisi PV, Callam MJ. Treatment for femoral pseudoaneurysms. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD004981.pub3] - DOI - PubMed

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