Korean Circ J.  2010 Jun;40(6):292-294. 10.4070/kcj.2010.40.6.292.

Successful Treatment of an Iatrogenic Giant Femoral Artery Pseudoaneurysm With Percutaneous Thrombin Injection

• Kim KS
• Youn JM
• Han WS
• Yoon YJ
• Yoo JH
• Gu DY
• Rhee I

• KMID: 2225191
• DOI: http://doi.org/10.4070/kcj.2010.40.6.292

Abstract

A femoral artery pseudoaneurysm (FAP) is one of the most troublesome complications following invasive procedures related to the femoral arterial access. Post-procedure FAP rarely occurs; however, its occurrence tends to increase with the more frequently antiplatelet agents, anticoagulants, and larger-sized catheter used for interventional procedures. Traditionally, surgical repair has been considered as the standard treatment modality for FAP; however, less invasive methods currently exist such as blind manual or ultrasound-guided compression repair (UGCR) as well as percutaneous thrombin injection, both of which have replaced the need for surgery. We report a case of a giant pseudoaneurysm in a femoral artery, which had developed as a complication of stenting in a patient with carotid artery stenosis and ischemic heart disease, and was subsequently successfully treated using percutaneous thrombin injection.

Keyword

Pseudoaneurysm; Carotid artery stenosis; Thrombin

MeSH Terms

Aneurysm, False
Anticoagulants
Carotid Stenosis
Catheters
Femoral Artery
Humans
Myocardial Ischemia
Platelet Aggregation Inhibitors
Stents
Thrombin
Anticoagulants
Platelet Aggregation Inhibitors
Thrombin

Figure

• 

  Fig. 1 Color flow demonstrating blood flow in right femoral artery, through the neck into the pseudoaneurysm (A), pseudoaneurysm recurred after UGCR had failed (B), needle entering the pseudoaneurysm (C), coagulation of blood after thrombin injection (D), occlusion of the right femoral artery with a balloon during the thrombin injection (E), completely obliterated neck and no blood signals within the pseudoaneurysm from the thrombus formation (F). UGCR: ultrasound-guided compression repair.

Reference

1. Webber GW, Jang J, Gustavson S, Olin JW. Contemporary management of postcatheterization pseudoaneurysms. Circulation. 2007. 115:2666–2674.

2. Ku BK, Kim HS, Ko CW, et al. A case of femoral artery pseudoaneurysm treated with compression guided by color Doppler ultrasound. Korean Circ J. 1995. 25:119–123.

3. Lenartova M, Tak T. Iatrogenic pseudoaneurysm of femoral artery: case report and literature review. Clin Med Res. 2003. 1:243–247.

4. Popovic B, Freysz L, Chometon F, et al. Femoral pseudoaneurysms and current cardiac catheterization: evaluation of risk factors and treatment. Int J Cardiol. 2008. DOI:10.1016/j.ijcard.2008.11.111.

5. San Norberto García EM, González-Fajardo J, Gutiérrez V, Carrera S, Vaquero C. Femoral pseudoaneurysms post-cardiac catheterization surgically treated: evolution and prognosis. Interact Cardiovasc Thorac Surg. 2009. 8:353–357.

6. Madaric J, Vulev I, Mistrik A, et al. The recurrence of iatrogenic femoral artery pseudoaneurysm after occlusion by ultrasound guided percutaneous thrombin injection. EuroIntervention. 2009. 5:443–447.

7. La Perna L, Olin JW, Goines D, Quriel K. Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. Circulation. 2000. 102:2391–2395.