A PROSPECTIVE STUDY OF THE TREATMENT OF PSEUDOANEURYSMS IN THE FEMORAL ARTERY WITH ULTRASOUND-GUIDED THROMBIN INJECTIONS: TOWARDS A LESS INVASIVE THERAPY

Introduction. Catheterizations and endovascular procedures in which the femoral artery is cannulated are sometimes complicated by iatrogenic pseudoaneurysms. A less uncomfortable technique involving the ultrasound scanguided injection of thrombin (UGTI) has been used more recently. Aim. To prospectively evaluate the effectiveness of UGTI as a treatment of iatrogenic femoral pseudoaneurysms. Patients and methods. 3,734 femoral artery catheterizations were performed, and from those, 32 consecutive patients with 33 femoral pseudoaneurysm (0.88%) of less than 8 cm were prospectively enrolled for UGTI. Results. The initial success rate was 100%. Thirty-one cases (93.9%) remained successfully thrombosed with a single injection at day 30. Recurrence of two pseudoaneurysms (6.1%) was sent at day 1 and day 8. More than half of the patients were on an inpatient basis (53.1%). Hospital stay was 1 to 9 days, with 88.2% of the patients released on day or 2. Ten of the last 11 cases needed less than 800 IU, and nearly half of the pseudoaneurysms (49%) were successfully thrombosed with less than 600 IU. No statistical significance was found between occurrence of the pseudoaneurysm and sheat size or between the size of the pseudoaneurysm and successful thrombosis. Conclusion. UGTI is an effective treatment. Not only is it minimally painful, but it can be done as an outpatient procedure and anticoagulation therapy does not hinder the success. Minimal thrombin seems necessary to successfully treat pseudoaneurysms that may further limit procedure-related complications.