Doppler ultrasound-guided percutaneous thrombin injection for treating femoral pseudoaneurysms

Objective: To evaluate the success rate of percutaneous injection of thrombin, guided by Doppler ultrasound to treat femoral pseudoaneurysms. Methods: Twenty-three patients with femoral pseudoaneurysms were treated with ultrasound-guided thrombin injection, between September 2003 and October 2007. Pseudoaneurysm size, dose of thrombin used, result of therapy and complications were prospectively documented. Other aspects analyzed included the type of procedure that caused the pseudoaneurysm (diagnostic catheterization, angioplasty, stent placement), size of endovascular introducer, use of hemostatic device and body mass index (BMI) of patients. Results: A total of 27 injections of thrombin were performed. The mean transverse diameter was 3.5 cm. The mean dose of thrombin injected was 666.7 IU. The primary success rate ranged from 19 to 23 (83%). Reperfusion occurred in one pseudoaneurysm. The rate of secondary thrombosis was four in four (100%). No thromboembolic, infectious or allergic complications occurred. Conclusions: Ultrasound-guided percutaneous thrombin injection is the best method for treating femoral pseudoaneurysms caused by endovascular procedures. It presents high rates of success, low recurrence rates and almost no complications.