Background: Femoral artery false aneurysms are a relatively common complication after cardiac catheterization. The majority of small pseudoaneurysms undergo spontaneous occlusion but larger ones usually require treatment.
Aim: To prospectively evaluate the efficacy and safety of percutaneous ultrasound – guided thrombin injection (UGTI) in the management of femoral artery pseudoaneurysms.
Methods: One hundred and eighty six consecutive patients (95 female, age 64.8 ± 11.3 years) with post-catheterization femoral artery pseudoaneurysm were treated with ultrasound-guided local thrombin injection. At the time of diagnosis 39 (21%) patients were receiving anticoagulation therapy, 103 (55.4%) antiplatelet therapy only, and 44 (23.6%) both types of therapy.
Results: A single-chamber pseudoaneurysm was diagnosed in 145 (78%) patients and complex pseudoaneurysm in 41 (22%). A total number of 198 thrombin injection was performed: 1.04 injection per patient with single-chamber pseudoaneurysm and 1.12 injections per patient with complex pseudoaneurym. The mean dose of injected bovine thrombin was 620 IU. UGTI was primarily successful in 175 of 186 patients (94%): in 139 (95.9%) patients with single-chamber and in 36 (87.8%) patients with complex pseudoaneurysms (p = 0.07). Including a second attempt the success rate was 143 (98.6%) patients for single-chamber and 40 (97.6%) patients for complex pseudoaneurysm (p = 0.52). In addition, one single-chamber pseudoaneurysm was obliterated after a third injection. Overall, the treated pseudoaneurysms were completely occluded in 184 (98.9%) patients. Final success rate did not differ between patients with single-chamber and complex pseudoaneurysms (99.3 vs. 97.6%, p = 0.39, respectively). Two major complications occurred: a symptomatic peripheral thrombosis and an episode of loss of consciousness.
Conclusions: Ultrasound guided occlusion of iatrogenic femoral artery pseudoaneurysms using thrombin injection is an efficacious and safe procedure.