Personal experiences in direct ultrasound guided injection of thrombin into the lumen of pseudoaneurysm as a method of treatment in case of iatrogenic femoral artery damage

Introduction: Pseudoaneurysms constitute quite common complication of procedures requiring the puncture of common femoral artery. The risk factors of the condition include: obesity, arterial hypertension, sex (more prevalent in males) as well as antithrombotic therapy.

Material/method: The US-guided injection of thrombin into the pseudoaneurysm lumen was performed in patients referred from the Department of Invasive Cardiology who had undergone coronarography or coronary angioplasty. Pseudoaneurysms constituted the complication of common femoral artery caniulation. After setting the diagnosis of the pseudoaneurysm by means of Doppler ultrasound, the patients with large pseudoaneurysms of volume more than 5ccm were qualified for trombin injection. Generally, 30 patients underwent the treatment. In 3 cases – due to the presence of multiocular pseudoaneurysm – thrombin was administered twice.

Results: In 23 cases after complete thrombosis of the pseudoaneurysm lumen was obtained after a couple of minutes since the thrombin injection. In 7 patients partial thrombosis of pseudoaneurysm lumen was visualised, the conservative treatment (compression) proved helpful to obtain the complete occlusion of the pseudoaneurysm. No complications were observed after performed procedures. No recanalisation of pseudoaneurysms was demonstrated in follow-up examinations.

Conclusions:

• Direct thrombin injection into the pseudoaneurysm lumen can constitute an alternative method of their treatment in relation to open surgical techniques.

• The procedure is highly effective, cheap and minimal-invasive method.