Duplex-guided thrombin injection for iatrogenic femoral artery pseudoaneurysm is effective even in anticoagulated patients

Background: The aim was to evaluate the efficacy and safety of percutaneous thrombin injection as an alternative non-operative method for treating pos tcatheterization femoral artery pseudoaneurysm in both anticoagulated and n on-anticoagulated patients. Methods: Thirty consecutive patients with a femoral artery pseudoaneurysm s econdary to radiological catheterization confirmed by duplex imaging were i ncluded. Thrombin 200-2000 units (1000 units/ml) in a titrating dose was in jected into the centre of the cavity under duplex ultrasonographic guidance . Thrombosis was assessed in real time using B mode and colour flow. No sed ation or anaesthesia was required during the procedure. The distal pulses a nd ankle pressures were evaluated before and immediately after the injectio n, to exclude propagation of thrombus into the femoral artery. Results: Successful rapid thrombosis of the false cavity was induced in all 30 patients. There were no immediate or mid-term procedure-related complic ations, or recurrences at 6 weeks, Eighteen patients were anticoagulated th erapeutically at the time and following the procedure with either heparin o r warfarin. Conclusion: Percutaneous thrombin injection is a simple, quick, painless, s afe and effective technique, particularly in patients taking anticoagulants .