Thrombin injection versus compression of femoral artery pseudoaneurysms

Objective: The compression of femoral artery pseudoaneurysms is a time cons uming, painful, and sometimes unsuccessful procedure, Thrombin injection ha s been advocated as a superior alternative. In this study,we compare our ex periences with both techniques. Methods: All the records of femoral artery false aneurysms that were treate d in the vascular laboratory from January 1996 to April 1999 were retrospec tively reviewed. Treatment with ultrasound scan-guided compression was comp ared with treatment with dilute thrombin injection (100 U/mL). Results: Both groups had similar demographics and aneurysm sizes (P > .2). Of the pseudoaneursyms, 88% were caused by cardiac catheterization and the others were the results of femoral artery access for cardiac surgery (6%), arteriography (5%), and renal dialysis (1%). Compression was successful in 25 of 40 patients (63%). Nine persistent aneurysms necessitated operation, and six were treated successfully with thrombin injection. Primary thrombin injection successfully obliterated 21 pseudoaneurysms in 23 patients. Over all, 27 of 29 pseudoaneurysms: were treated successfully with thrombin inje ction (93%). Thrombosis occurred within seconds of the thrombin injection a nd required, on average, 300 units of thrombin (100 to 600 units). The pati ents who underwent successful compression required an average of 37 minutes of compression (range, 5 to 70 minutes) and required analgesia on several occasions. No patients in the thrombin group required analgesia or sedation . Neither group had complications. A cost analysis shows that thrombin trea tment results in considerable savings in vascular laboratory resource use b ur, not in overall hospital expenditures. Conclusion: Ultrasound scan-guided thrombin injection is a safe, fast, and painless procedure that completely obliterates femoral artery pseudoaneurys ms. The shift from compressive therapy to thrombin injection reduces vascul ar laboratory use and is less expensive, although it does not significantly impact hospital costs.