Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms: A prospective analysis

An adverse consequence of the use of the femoral artery for the endovascula r evaluation and treatment of arterial disease is the increased incidence o f iatrogenic femoral pseudoaneurysms. Although surgical repair has traditio nally been used to treat such aneurysms, less invasive modalities have emer ged. The purpose of this study is to prospectively evaluate ultrasound-guid ed thrombin injection (UGTI) for the treatment of iatrogenic femoral pseudo aneurysms. A treatment protocol was approved and 30 stable patients (21 fem ale; age range 43-85 years; mean 67 years) were prospectively enrolled from December 1997 through June 1999 to undergo UGTI on 30 iatrogenic femoral p seudoaneurysms. Pseudoaneurysms occurred after cardiac intervention (n = 22 , 73%), peripheral intervention (n = 7,23%), and after a femoral line place ment (n = 1, 3%). They ranged in size from one to 5 cm with a time interval from intervention until UGTI of one to 132 Rays (median 3 days). Eleven pa tients (37%) were systematically anticoagulated at the time of UGTI. All ps eudoaneurysms were treated using sterile technique and local anesthesia wit h ultrasound-guided injection via a 20-gauge spinal needle of 0.1 to 2 cm(3 ) (median 0.6 cm(3)) of 1000 units/cm(3) topical thrombin solution administ ered by one of six physicians. A period of bedrest for 4 to 6 hours after i njection was followed by repeat groin duplex scan at 24 hours and a clinica l follow-up at 30 Rays. There were no procedural deaths or nonvascular comp lications. Twenty-seven (90%) UGTIs resulted in successful pseudoaneurysm a blation with no recurrences at 24 hours or 30 days. Two (7%) UGTIs failed a nd one (3%) femoral artery embolic complication occurred; all were successf ully treated with surgery. Success appeared to be independent of anticoagul ation status, pseudoaneurysm age, size, or operator experience. We conclude that UGTI is a safe, easy, well-tolerated and effective noninvasive method for treatment of iatrogenic femoral pseudoaneurysms and should be consider ed in all stable patients before operative repair.