Ultrasound-Guided Thrombin Injection Therapy for the Treatment of Iatrogenic Femoral Pseudoaneurysms

(Department of Thoracic and Vascular Surgery, Takaoka City Hospital, Takaoka, Japan)

Masayasu Yokokawa
Femoral pseudoaneurysm is a common complication in percutaneous catheterization. Ultrasound-guided thrombin injection (UGTI) therapy has been developed as a less invasive and highly successful treatment of a femoral pseudoaneurysm. We performed UGTI therapy for 3 patients with iatrogenic femoral pseudoaneurysms that formed after femoral artery catheterization. Case1 was a 76-year-old woman. Following the catheterization procedure, she developed a right femoral pseudoaneurysm and refused operative repair. After obtaining informed consent, we performed UGTI therapy for the pseudoaneurysm. Immediately after the treatment, the pain caused by the pseudoaneurysm disappeared and no recurrence has been seen. Case2 was a 72-year-old woman. Following withdrawal of the transfemoral catheter, a right femoral pseudoaneurysm appeared. We performed UGTI therapy for the pseudoaneurysm, which became thrombotic after treatment. Case3 was an 87-year-old man with a right femoral pseudoaneurysm after the catheterization procedure. We performed UGTI therapy for the pseudoaneurysm on 2 separate occasions, however, recurrence occurred following both and he finally underwent open surgical repair. In the present Cases1, 2, and 3, the sizes of the catheters used were 6, 8, and 11.5 Fr, respectively. Two of the patients were receiving percutaneous coronary artery intervention and continued undergoing anticoagulant therapy at the time of the injection. For all 3 patients, we injected human thrombin into the pseudoaneurysm percutaneously under ultrasound guide. Cases1 and 2 had no recurrence after the first treatment, whereas Case3 had 2 instances of pseudoaneurysm recurrence after treatment and finally received surgical repair. There were no complications derived from the treatment in any of the cases, nor was there evidence of embolism or allergic reaction originating from the thrombin. We concluded that UGTI therapy should be considered as an alternative treatment for a femoral pseudoaneurysm that occurs after catheterization.
@Jpn. J. Cardiovasc. Surg. 36: 356-360 (2007)