Ultrasound-Guided Percutaneous Thrombin Injection in Iatrogenic Femoral Artery Pseudoaneurysms: A Single Center Experience

Objective: The aim of this study is to share our experience of ultrasound-guided percutaneus thrombin injection in the treatment in iatrogenic femoral artery pseudoaneurysms and discuss about the safety and efficacy of this minimally invasive treatment. Material and Methods: Fourty-two patients (26 female, 16 male) with iatrogenic femoral artery pseudoaneurysms treated with percutaneous ultrasound-guided thrombin injection between June 2012 and August 2017 were retrospectively evaluated. The diameter and the number of the pseudoaneurysm sac, artery of origin, pseudoaneurysm shape and structure were identified by Doppler ultrasound and thrombin was injected via a 21 G needle. Control with Doppler ultrasound was performed on the first day and one weekafter the procedure. Results: The mean age of the patients included in the study was 66 years (range: 46-88 years). Thirty-three percent of pseudoaneurysm sacs had originated from the superficial femoral artery and 67%from the common femoral artery. Mean pseudoaneurysm diameter was 36.7 mm (range: 19-55 mm), mean neck lenght was 21 mm and mean neck diameter was 3.2 mm. Pseudoaneurysm in 50%of the patients was partially thrombosed, while 8 patients had two or more synchronous pseudoaneurysms and 8 patients had multilobulated pseudoaneurysm sacs. Pseudoaneurysms were completely thrombosed with a single injection in 83%of patients. In two patients, pseudoaneurysms were thrombosed with mild compression in addition to thrombin injection during the first procedure. Four patients’ pseudoaneurysms were thrombosed after a second injection within the first week because of recurrence. In one patient, the pseudoaneurysm sac enlarged after procedure and required stent-graft owing to superficial femoral artery compression and occlusion. Technical, primary and secondary success rates were 100%, 93% and 98% respectively. No complications occured during the procedure. Conclusion: Ultrasound-guided percutaneus thrombin injection is a reliable and effective method that can be easily applied even in numerous and multilobulated pseudoaneurysms