Treatment of an iatrogenic false aneurysm of the femoral artery by direct injection of thrombin

Background and objective: After percutaneous catheter introduction a faire aneurysm occasionally develops at the site of puncture. This has been treat ed either surgically or, more recently, by ultrasound-guided compression. A new method has been tried in which the false aneurysm is thrombosed by inj ecting thrombin into it. Patients and methods: In 29 patients thrombin was injected directly into th e false aneurysm of the femoral artery, caused by catheter introduction int o the vessel. Puncture of the aneurysm and injection of the thrombin soluti on was performed with continuous duplex-sonographic monitoring. The patient s' age ranged from 42 to 88 years (mean 71 +/- 12 years). The false aneurys m had occured after diagnostic catherization (n=5), balloon dilatation of p eripheral vessels (n=5) or balloon catheter dilatation of the coronary arte ries (n=19) with catheters size 5F (n=4), 6F(n=6), 8F (n=16) or 9-13F(n=3). The catheterization had been done 1-30 days previously (mean 5.3 +/- 6.9 d ays). The diameter of the aneurysm ranged from 2.1 to 5 cm (mean 3.5 +/- 0. 9 cm). Results: The aneurysms thrombosed within seconds after infection of 0.075 t o 1.5 ml (mean 0.4 +/- 0.4 ml). All interventions were successful and witho ut complications. Any resulting haematoma regressed within a few days to a few weeks and none recurred. In two patients a persisting haematoma had lat er to be removed surgically, and in another patient a second aneurysm was r emoved surgically without prior thrombin injection. Conclusion: A false aneurysm of the femoral artery caused by percutaneous c atheterization can be successfully thrombosed by direct thrombin injection.