Minimally invasive percutaneous contrast-ultrasound guided thrombin occlusion of iatrogeneous pseudoaneurysm

Background Complicating femoral artery puncture aneurysms may occur resulti ng in the need for surgical or newer, non- or minimal-invasive therapy: A n ew minimal-invasive method is the percutaneous occlusion injecting bovine t hrombin. The high thrombogenous potential of thrombin bears the risk of iat rogenic artery occlusion by artificial intravascular instillation. Aim Is t he contrast-ultrasound guided thrombin injection safe and effective in occl uding femoral aneurysms? Methods During 1/99 to 12/00, 33 femoral artery an eurysms as a complication coronary catheterization were diagnosed. In 32 pa tients the aneurysm (mean dimensions 32 x 35 x 24 mm) was punctured during ultrasound guidance. By injecting ultrasound contrast medium, the flow patt ern perfusing the aneurysm was documented. in the canula position where no contrast medium exited the aneurysm thrombin was injected. Results Complete occlusion of the aneurysm was achieved in 96.9% (31 out of 32) of the pati ents by contrast-ultrasound guided thrombin occlusion. Follow-up for up to 3 months after the procedure revealed complete occlusion and no clinical or sonographical complications. In one case, a large aneurysm (50 mm x 62 mm x 27 mm) had already led to skin alterations and was only partly occluded b y thrombin injection. Conclusions Contrast-ultrasound guided thrombin occlu sion of femoral artery aneurysms is safe and highly effective.