Treatment of iatrogenic femoral arterial pseudoaneurysms: Comparison of US-guided thrombin injection with compression repair

PURPOSE: To evaluate and compare the treatment of iatrogenic femoral arteri al pseudoaneurysms by using ultrasonographically (US) guided direct thrombi n injection with US-guided compression repair. MATERIALS AND METHODS: Twenty-six patients with iatrogenic femoral arterial pseudoaneurysms were treated with direct thrombin injection. With US guida nce, a 22-gauge needle was placed into the pseudoaneurysm flow lumen and th rombin (mean volume, 0.35 mL; range, 0.10-0.60 mL) was injected with contin uous color Doppler US guidance. Demographics, clinical variables, pseudoane urysm characteristics, and results in these patients were compared with tho se in 281 consecutive patients who underwent US-guided compression repair. RESULTS: The success rate of thrombin injection was 96% (25 of 26 patients) , which was significantly higher than that of compression, 74% (209 of 281 patients) (P = .013). Twenty of 26 (77%) patients required a single injecti on, and six (23%) required two injections, Mean thrombosis time for thrombi n injection was 6 seconds, compared with 41.5 minutes for compression. For thrombin injection, there were no complications, foot pulses did not change and no patients required conscious sedation. Follow-up US at 24 hours show ed no recurrent pseudoaneurysms. CONCLUSION: For the treatment of iatrogenic femoral arterial pseudoaneurysm s, thrombin injection with US guidance appears to be superior to compressio n repair.