Print this pageReducing Duplex Examinations in Patients with Iatrogenic Pseudoaneurysms
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Patrick A. Stone, MD1, Ali F. AbuRahma, MD2, Sarah K. Flaherty, BS2.
1University of South Florida, Tampa, FL, USA, 2West Virginia University, Charleston, WV, USA.
Objective(s): Ultrasound guided thrombin injection (UGTI) has become the initial treatment of choice for femoral access related pseudoaneurysms (IPSA). Patients typically undergo serial duplex examinations to assess for spontaneous resolution of small pseudoaneurysms (<2.5cm), or may require repeated studies for larger IPSA (>2.5cm) including (diagnostic, therapeutic and follow-up). We evaluated the impact of a revised treatment algorithm, which includes primary treatment of both small and larger pseudoaneurysms (<2.5cm) rather than observation of smaller ones, and attempts at establishing a single duplex examination via a point of care treatment strategy.
Methods: One-hundred and five consecutive patients treated with UGTI from July 2001 through December 2004 were reviewed. Patient, IPSA characteristics and treatment methods were examined. The number of duplex examinations per patient was evaluated over the treatment interval. Also a comparison of primary treatment of small ISPA as opposed to observation with serial duplex examinations was completed based on published cost data..
Results: Successful thrombosis occurred in 103/105 treated pseudoaneurysms (98.1%). The recurrence rate for the series was 1.9% (2/105) of cases. Forty-three of forty-four small (<2.5cm) IPSA were successfully treated with a single injection (97.7%), while one required a second injection. No minor or major complications occurred following thrombin injection in either small or large ISPA, and both failures requiring operation were in the large aneurysm group. The average number of duplex exams per patient in our first year of treatment experience was 3.3, which declined to 1.5 by our third year with the institution of a point of care service model for all pseudoaneurysms. Based on this decreased use of duplex and an average treatment cohort of 35 IPSA patients per year at our institution, this results in a reduction in patient charges of $25,200 per year. Similarly for small pseudoaneurysms, point of service primary treatment program rather than observation results in an estimated reduction of patient changes from $23,600 to $7200 based on treating 15 small IPSA per year and a 2% recurrence rate, compared to 3 duplex examinations required during most observation models. (p<0.0001.)
Conclusions: Ultrasound guided thrombin injection is safe and effective for the treatment of nearly all iatrogenic pseudoaneurysms. We recommend primary treatment of small pseudoaneurysms by ultrasound guided thrombin injection rather than observation with serial duplex scans. This point of care treatment algorithm resulted in cost savings by reducing the number of necessary duplex examinations