In Reply to: Case 0298_06 -- Occlusion of brachial artery pseudoaneurysm posted by Editor on February 03, 1998 at 11:59:26:
Nice case. I particularly like the occlusion balloon to protect the brachial artery. Perfusion balloons will be quite helpful by allowing prolonged inflation times as needed. Interestingly, some centers are employing direct percutaneous injection of thrombin into femoral pseudoaneurysms without protecting the artery with good results (J Vasc Surg 26: 18-23, Jul 1997 Treatment of iatrogenic femoral artery pseudoaneurysm with percutaneous thrombin injection). A poster at the upcoming SCVIR meeting describes the use of "fibrin glue" for pseudoaneurysms (po 221). This is commercially available abroad but can be easily made in the lab here. Using a dual needle technique, the fibrin glue polymerizes rapidly allowing the rapid obliteration of pseudoaneurysms without prolonged inflation times of the balloon across the neck. One nice thing about the glue is that you can titrate the volume of clot produced to correspond to the size of the lesion to be filled.