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Investigation of Percutaneous Thrombin Injection for Iatrogenic Femoral Artery Pseudoaneurysms with Complex Morphologies
44 Pages Posted: 23 Apr 2025
More...Abstract
Background: The increasing prevalence of cardiovascular diseases has resulted in a higher incidence of iatrogenic femoral artery pseudoaneurysms, which are vascular complications that frequently occur following diagnostic or therapeutic vascular interventions such as angiography. Ultrasound-guided thrombin injection (UGTI) is widely used to treat pseudoaneurysms, but challenges persist regarding complex pseudoaneurysm morphologies. To evaluate the performance of the UGTI under complex morphological conditions, we developed six pseudoaneurysm models based on clinical data and analyzed experimentally and numerically.Methods: A bidirectional pulsatile flow generator is used for plasma flow in experimental setup, varying thrombin concentrations to pseudoaneurysm morphologies for a particular injection time. Computational fluid dynamics (CFD) simulations were also conducted to assess technical and treatment success, thromboembolism risk, and fibrin formation.Findings: A significant correlation between the morphological factors and treatment outcomes is observed in the experimental findings. Neck width was identified as the most critical parameter influencing thromboembolism and coagulation efficacy. Models with neck widths ≥10 mm and neck lengths ≤5 mm exhibited low success rates and increased thromboembolism volumes. Variations in thrombin concentrations of 100, 500, and 1000 IU for severely complex shapes demonstrated higher success rates for 500 IU. A thromboembolism volume threshold of 20 mL was proposed as a cutoff value for the risk indicator. CFD simulations utilizing a thrombin-induced thrombosis model validated the experimental findings and provided insights into thrombin distribution and coagulation dynamics. Interpretation: These results enhance the understanding of the treatment challenges in pseudoaneurysms with complex morphologies and provide practical guidelines for enhancing treatment efficacy while minimizing complications.Funding: National Research Foundation of Korea (NRF) grant funded by the Korean Government (2022R1A2C1093364), NRF grant funded by the Ministry of Science, ICT, & Future Planning (NRF2020R1A2C3010568), NRF funded by the Ministry of Education (NRF2021R1A6A1A03039696).
Keywords: Percutaneous Thrombin Injection, Iatrogenic Pseudoaneurysms, Complex Dimensions, Thrombin Concentration, Computational Fluid Dynamics
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