How to Perform Ultrasound-Assisted Thrombin Injection for Closure of Iatrogenic Femoral Pseudoaneurysm

A novel technique for iatrogenic pseudoaneurysm obliteration with ultrasound-guided thrombin foam injection

BACKGROUND

Iatrogenic pseudoaneurysms (IPA) are treated with ultrasound-guided thrombin injections (UGTI). We describe a novel technique for IPA repair that applies UGTI with thrombin foam (UGTFI).

METHODS AND RESULTS

Successful obliteration of 6 IPAs (IPA without a neck, n = 5; with a neck, n = 1) in 6 patients (2 males, aged 68 ± 1 years, 4 females, aged 59 ± 11 years) was performed by using UGTFI. The dose of administered thrombin was 25-75 IU. No microembolization phenomenon and no serious clinical complications were observed.

CONCLUSIONS

Treatment of IPA with UGTFI may reduce the embolization rate, risk of IPA cavity thrombin leakage, required drug dose. Use of the thrombin foam could be the next step in the development of the UGTI, particularly in the treatment of IPA without a neck.

Delayed femoral pseudoaneurysm formation after percutaneous coronary intervention

Five femoral pseudoaneurysms were treated among 573 patients who underwent percutaneous coronary interventions. Four of the five patients suffered from diabetes mellitus and four patients needed regular hemodialysis due to chronic renal failure. One patient's course was complicated by infection. One patient was healed by compression therapy and four patients were treated successfully by surgery, which included an extraanatomic bypass and a thromboendoarterectomy. Diabetes and regular hemodialysis are major risks for the formation of femoral pseudoaneurysm after catheter intervention at present.