Treatment of iatrogenic femoral pseudoaneurysms with percutaneous thrombininjection: Experience in 54 patients

PURPOSE: To assess the clinical success of ultrasonography (US)-guided thro mbin injection for the treatment of iatrogenic femoral pseudoaneurysms and to identify criteria that may predispose to treatment failure. MATERIALS AND METHODS: Fifty-four iatrogenic femoral pseudoaneurysms were t reated with US-guided thrombin injection. Forty-five were classified as sim ple (single lobe) and nine, as complex (at least two lobes and a single nec k to the native vessel). Pseudoaneurysm volume, classification, thrombin do se, anticoagulation therapy status, and sheath size were compared between f ailed and successful cases. Seven- to 10-day follow-up US and a minimum 4-m onth clinical follow-up were also performed to evaluate success. RESULTS: Fifty of 54 pseudoaneurysms were successfully treated with topical thrombin without complication and included all 45 simple and five of nine complex pseudoaneurysms. US follow-up in all 50 successful cases and clinic al follow-up in 37 of these revealed no recurrence. Only a complex pseudoan eurysm classification was significantly associated with failure (P < .01). Among the complex pseudoaneurysms, successful cases involved two injections and a total thrombin dose of at least 1,500 units. In failed cases, pseudo aneurysms were treated with a single injection of 1,000 units, initially th rombosed, and recurred. CONCLUSION: Simple iatrogenic femoral pseudoaneurysms, regardless of size o r concomitant anticoagulation therapy, can be treated with a single injecti on of up to 1,000 units of topical thrombin and require no follow-up. Compl ex pseudoaneurysms will likely require a second injection (total thrombin d ose of at least 1,500 units) and short-term clinical and US follow-up to en sure successful treatment.