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Ultrasound-guided thrombin injection in the management of pseudoaneurysm after percutaneous arterial access

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Jargiełło T. , Sobstyl J. , Światłowski Ł. , Kuczyńska M. , Kuklik E. , Sojka M. , Drelich-Zbroja A. , Pech M. , Powerski M.

Journal of Ultrasonography

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2018

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tom 18

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nr 73

85-89

EN

Aim: The purpose of this paper was to evaluate the efficacy of ultrasound-guided percutaneous thrombin injection as a treatment method for arterial access site pseudoaneurysm. Materials and methods: A total of 148 patients with iatrogenic arterial access site pseudoaneurysms were treated in the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin. Of those, 142 pseudoaneurysms were located in the common femoral artery, 3 in the brachial artery and the remaining 3 in the radial artery. The study included 77 woman and 71 men (mean age 64.5 ± 14 years). Patients were qualified for percutaneous thrombin injection after Doppler examination during which pseudoaneurysm size and morphology were assessed as well as the presence of arteriovenous fistula was excluded. Results: In the reported study, 94.8% (128/135) of patients were successfully treated during the initial thrombin injection. Additional 400 IU dose of thrombin after 24 hours was effective in 5 out of 7 patients with recanalization during the follow-up. A total of 98.5% (133/135) of patients were successfully treated with a percutaneous ultrasound-guided thrombin injection. Conclusions: The 10-year experience presented in this study as well as literature reports prove that percutaneous ultrasound-guided thrombin injection is an effective and safe treatment method for iatrogenic arterial access site pseudoaneurysm.

PL

Cel pracy: Celem pracy była ocena skuteczności przezskórnego wstrzyknięcia trombiny pod kontrolą ultrasonografii jako sposobu leczenia tętniaka rzekomego w miejscu dostępu tętniczego. Materiał i metody: W Zakładzie Radiologii Zabiegowej i Neuroradiologii Uniwersytetu Medycznego w Lublinie leczeniu poddano 148 pacjentów z jatrogennymi tętniakami rzekomymi w miejscu dostępu tętniczego, przy czym 142 pseudotętniaki były umiejscowione w tętnicy udowej wspólnej, 3 w tętnicy ramiennej oraz pozostałe 3 w tętnicy promieniowej. W badaniu udział wzięło 77 kobiet i 71 mężczyzn (średni wiek 64,5 ± 14 lat). Pacjentów kwalifikowano do przezskórnego wstrzyknięcia trombiny po wykonaniu badania ultrasonograficznego z funkcją dopplera w celu oceny wielkości i morfologii tętniaka rzekomego oraz wykluczenia obecności przetoki tętniczo-żylnej. Wyniki: W przedstawionym badaniu skuteczność leczenia po pierwszym wstrzyknięciu trombiny uzyskano u 94,8% (128/135) pacjentów. Dodatkowa dawka trombiny wynosząca 400 j.m. podana po upływie 24 godzin okazała się skuteczna u 5 na 7 pacjentów, u których podczas badania kontrolnego stwierdzono rekanalizację. Skuteczność leczenia metodą przezskórnego wstrzyknięcia trombiny pod kontrolą ultrasonografii uzyskano u 98,5% (133/135) badanych. Wnioski: Z przedstawionego w niniejszej pracy 10-letniego doświadczenia oraz doniesień z piśmiennictwa wynika, że przezskórna podaż trombiny pod kontrolą ultrasonografii stanowi skuteczną i bezpieczną metodę leczenia jatrogennych tętniaków rzekomych w miejscu dostępu tętniczego.

2

Non-enzymatic activation of prothrombin induced by interaction with fibrin β26-42 region

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Chernyshenko V. , Chernyshenko T. , Korolova D. y. , Volynets G. , Kolesnikova I. , Platonova T. , Lugovskoy E.

Acta Biochimica Polonica

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2015

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tom 62

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nr 3

517-522

EN

We have discovered that addition of monomeric desAB fibrin to prothrombin leads to appearance of the thrombin-like activity of prothrombin towards S2238 chromogenic substrate. DesA and desABβ(15-42)2 fibrin forms did not cause any activation of prothrombin. From this observation we could suggested that amino acid residues of the 15-42 fragment of BβN-domain presented in desAB fibrin, cleaved in desABβ(15-42)2 fibrin and protected in desA fibrin, play a crucial role in the non-enzymatic activation of prothrombin. To identify the Bβ amino acid residues involved in the fibrin-prothrombin binding we used monoclonal antibodies 1-5G and 2d2a with epitopes in Bβ26-42 and Bβ12-26 fibrin fragments respectively. The thrombin-like activity in the mixture of prothrombin and desAB fibrin was monitored in the presence of each of these monoclonal antibodies. It was found that anti-Bβ12-26 antibody does not exhibit any inhibitory effect on the thombin-like activity of the mixture. In contrast, adding of Bβ26-42 antibody into the mixture of desAB fibrin with prothrombin diminished the thrombin-like activity by 70%. Recombinant dimeric peptides Bβ(15-44)2 and Bβ(15-66)2 that mimic amino acid residues in fibrin were also tested for their ability to activate prothrombin. It was found that both peptides were able to induce non-enzymatic activation of prothrombin. The activation was more evident in the case of Bβ(15-44)2 peptide. From the data obtained we can conclude that desAB fibrin binds to prothrombin through the Bβ26-42 amino acid residues and the formation of such a complex caused a non-enzymatic activation of prothrombin.

3

Effect of bed rest on the adenine nucleotides concentration in human blood platelets

75%

Buczynski A. , Kedziora J. , Wachowicz B. , Zolynski K.

Journal of Physiology and Pharmacology

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1991

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tom 42

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nr 4

EN

The effect of immobilization in bed on metabolism and function of human blood platelet was studied. Blood platelets taken from patients with bone fractures after long term bed rest (14 days and 28 days) demonstrated significantly reduced concentration of total adenine nucleotides (after 28 days reduction about 30%). This decrease of total platelet adenine nucleotides af er immobilization in bed is probably caused by s imulation of platelet secretory process. Thrombin which released from confrol platele s 58.2%±1.5% of total adenine nucleotides liberated decreased amounfs (only 23.1 %±3.3% of total) of nucleotides from patient platelets isolated after 28 days of immobilization in bed. Loss of nucleotides from platelets was accompanied by sligh ly increased extent of platelet aggregation. It is concluded that during bed rest the reactivity of blood platelets (aggregation and release reaction) is stimulated.

4

Cleavage of prothrombin bound in immune complexes results in high thrombin enzymatic activity

75%

Pajdak W. , Radwan J. , Guzik T. J.

Journal of Physiology and Pharmacology

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2004

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tom 55

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nr 2

EN

Thrombin plays a pivotal role in blood clotting as well as in the regulation of vascular remodeling and oxidative stress. Recent evidence suggests that auto-antibodies directed against prothrombin, may play an important role in the pathogenesis of atherosclerosis. It is however not clear, if prothrombin bound in an immune complex retains its clotting and regulatory properties or acts solely by increasing vascular inflammation. In order to answer this question, we used a newly developed stain for the detection of thrombin activity of such complexes. Plasma and serum samples were subjected to rocket immunoelectrophoresis in an anti-prothrombin antiserum containing agarose gel. Gel plates, covered with a nitrocellulose membrane were soaked with chromogenic thrombin substrate. The product of thrombin activity was diazotized to red azo dye bound to nitrocellulose. Activity stain revealed barely discernible rockets in plasma, but heavily stained ones in serum. Pre-incubation with trypsin enhanced activity of immunoprecipitates deriving from plasma, but not from serum. Densitometric analysis showed, that the trypsin-enhanced activity in plasma derived immune complexes was twice as high as in serum derived immunoprecipitates. Thrombin active centre is not blocked by anti-prothrombin antiserum allowing to retain thrombin activity. Moreover, prothrombin in immunoprecipitate is readily cleaved by proteolytic enzymes. This cleavage could potentially be enhanced by antibody binding, although these results need to be confirmed using different antibodies.

5

Układ hemostazy a nowotwór złośliwy

63%

Kozłowski P. , Faryna M.

Laboratorium - Przegląd Ogólnopolski

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2015

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tom nr 3-4

32--34

PL

Choroba nowotworowa niezmiennie kojarzy się z zaburzeniami układu hemostazy. Wpływ rozwijającego się nowotworu na układ hemostazy powoduje najczęściej indukcję stanu nadkrzepliwości.

EN

Cancer invariably associated with disorders of hemostasis. Effect of tumor growing hemostatic system is in most cases the induction of a hypercoagulable state.

6

Protein C activation peptide inhibits the expression of ICAM-1, VCAM-1, and interleukin-8 induced by TNF-alpha in human dermal microvascular endothelial cells

63%

Del Socorro Pina-Canseco M. , Paez-Arenas A. , Masso F. , Perez-Campos E. , Martinez-Cruz R. , Hernandez-Cruz P. , Majluf-Cruz A. , Martinez-Cruz M. , Perez-Campos Mayoral L. , Perez-Santiago A. D. , Zenteno E.

Folia Histochemica et Cytobiologica

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2012

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tom 50

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nr 3

7

Effects of submaximal physical exercise and immobilization in bed on the adenine nucleotides concentration in human blood platelets

63%

Buczynski A. , Kedziora-Kornatowska K. , Kedziora J. , Wachowicz B.

Journal of Physiology and Pharmacology

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1995

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tom 46

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nr 2