Document Detail


Surgery versus non-surgical treatment for femoral pseudoaneurysms.
MedLine Citation:
PMID:  16437508     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, while others need definitive treatment. Surgery is considered the gold-standard treatment, although 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.
OBJECTIVES: To assess the effects of different treatments for femoral pseudoaneurysms resulting from endovascular procedures, specifically assessing less invasive treatment options such as ultrasound-guided compression or percutaneous thrombin injection.
SEARCH STRATEGY: We searched the Cochrane Peripheral Vascular Diseases Review Group's Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 3, 2005 (last searched October 12, 2005). Additional searches were also made of bibliographies of papers found through these searches and by handsearching relevant journals.
SELECTION CRITERIA: Randomised controlled trials comparing two treatments for femoral pseudoaneurysms following vascular interventional procedures were considered for inclusion in the review.
DATA COLLECTION AND ANALYSIS: Two studies were included in the analysis: ultrasound-guided application of a mechanical device (FemoStop) versus blind application; ultrasound-guided compression versus percutaneous thrombin injection. Data were extracted independently by both authors.
MAIN RESULTS: Mechanical compression with a FemoStop was effective in achieving thrombosis of the pseudoaneurysm although ultrasound-guided application of this failed to confer any benefit (relative risk (RR) 1.07; 95% confidence intervals (CI) 0.75 to 1.53, P = 0.7). Percutaneous thrombin injection was more effective than ultrasound-guided compression in achieving thrombosis of a pseudoaneurysm (RR 7.50; 95% CI 2.06 to 27.25, P = 0.002 at 24 hours after treatment; RR 2.50; 95% CI 1.35 to 4.65, P = 0.004 at 48 hours after treatment). There was no statistically significant difference in the length of hospital stay between the two groups and no complications were reported.
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 ultrasound-guided compression as first-line treatment, reserving thrombin injection for those in whom the procedure fails.
Authors:
P V Tisi; M J Callam
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Publication Detail:
Type:  Journal Article; Review     Date:  2006-01-25
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2006  
Date Detail:
Created Date:  2006-01-26     Completed Date:  2006-04-07     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD004981     Citation Subset:  IM    
Affiliation:
Bedford Hospital, Department of Vascular Surgery, Kempston Road, Bedford, Bedfordshire, UK, MK42 9DJ. pvtisi@rcsed.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Aneurysm, False / surgery,  therapy*
Femoral Artery* / surgery
Hemostatics / therapeutic use
Humans
Pressure
Randomized Controlled Trials as Topic
Thrombin / therapeutic use
Ultrasonic Therapy / methods
Ultrasonography, Interventional
Chemical
Reg. No./Substance:
0/Hemostatics; EC 3.4.21.5/Thrombin
Comments/Corrections
Update In:
Cochrane Database Syst Rev. 2009;(2):CD004981   [PMID:  19370614 ]

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