Experimental investigation of ultraguided thrombin injection outcomes in complex morphologies of iatrogenic femoral artery pseudoaneurysms

초록

Background The increasing prevalence of cardiovascular diseases has resulted in a higher incidence of iatrogenic femoral artery pseudoaneurysms, which are vascular complications that occur following diagnostic or therapeutic vascular interventions. Ultrasound-guided thrombin injections are widely used to treat pseudoaneurysms, but challenges persist regarding complex pseudoaneurysm morphologies. Objectives Evaluate the performance of the ultrasound-guided thrombin injection under complex morphological conditions. Methods Six pseudoaneurysm models were developed based on clinical data and analyzed experimentally and numerically. A bidirectional pulsatile flow generator was used to generate plasma flow in the experimental setup, with varying thrombin concentrations to assess pseudoaneurysm morphologies at a particular injection time. Computational fluid dynamics simulations were also conducted to assess technical and treatment success, as well as thromboembolism risk. Results A significant correlation between morphological factors and treatment outcomes was observed in the experimental findings, with neck width identified as the most critical parameter influencing thromboembolism and coagulation efficacy. In vitro models with neck widths ≥ 10 mm and lengths ≤ 5 mm exhibited low success rates and increased thromboembolism volumes. Variations in thrombin concentrations (100, 500, and 1000 IU) for complex shapes demonstrated higher success rates, specifically at 500 IU. A thromboembolism volume threshold of 20 mL was proposed as a cutoff value for the risk indicator. Computational fluid dynamics simulations using a thrombin-induced thrombosis model validated the experimental findings and provided insights into thrombin distribution and coagulation dynamics. Conclusion These results enhance understanding of the treatment challenges in pseudoaneurysms with complex morphologies and provide practical guidelines to improve treatment efficacy while minimizing complications.

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