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False aneurysms develop at the puncture site in up to 6% of percutaneous cardiovascular procedures. Previous management of false aneurysms consisted of surgical repair or compression therapy. Drawbacks of surgery are its invasiveness, compression therapy pain, and prolonged compression bandages. An alternative to both is selective injection of thrombin into the false aneurysm. However, its effectiveness in complex, double chamber aneurysms in patients treated with enoxaparin, aspirin and clopidogrel, and abciximab is not clear as yet.
After an acute invasive procedure using a 6 French sheath in a 79 year old man with acute myocardial infarction, a complex two chamber false aneurysm occurred. The patient was not suitable for compression therapy because of intense pain, despite local lidocaine injections and systemic morphine (15 mg). The surgeons refused to operate on the patient because of systemic anticoagulation (enoxaparin subcutaneously, 1.0 ml twice per day) and treatment with aspirin (500 mg initial dose, followed by 100 mg/day), clopidogrel (300 mg initial dose, followed by 75 mg/day) and weight adjusted abciximab.
To induce clot formation, “chamber I” was punctured percutaneously under ultrasound guidance with a 20 gauge needle. Brief aspiration and re-injection of blood confirmed the correct position of the needle. After injection of 550 U of diluted thrombin solution (GenTrac, Middleton, Wisconsin, USA) thromboses of both chambers occurred. The patient received a cool pack for two hours. No complications occurred until hospital discharge.
Therefore, thrombin injections are effective for management of false aneurysms, even in patients with a complex anatomy and treatment with systemic anticoagulation and high dose anti-aggregation therapy.