Treatment of iatrogenic femoral arterial pseudoaneurysms: comparison of US-guided thrombin injection with compression repair.
OBJECTIVE
To evaluate and compare the treatment of iatrogenic femoral arterial pseudoaneurysms by using ultrasonographically (US) guided direct thrombin injection with US-guided compression repair.


METHODS
Twenty-six patients with iatrogenic femoral arterial pseudoaneurysms were treated with direct thrombin injection. With US guidance, a 22-gauge needle was placed into the pseudoaneurysm flow lumen and thrombin (mean volume, 0.35 mL; range, 0.10-0.60 mL) was injected with continuous color Doppler US guidance. Demographics, clinical variables, pseudoaneurysm characteristics, and results in these patients were compared with those in 281 consecutive patients who underwent US-guided compression repair.


RESULTS
The success rate of thrombin injection was 96% (25 of 26 patients), which was significantly higher than that of compression, 74% (209 of 281 patients) (P =.013). Twenty of 26 (77%) patients required a single injection, and six (23%) required two injections. Mean thrombosis time for thrombin injection was 6 seconds, compared with 41.5 minutes for compression. For thrombin injection, there were no complications, foot pulses did not change and no patients required conscious sedation. Follow-up US at 24 hours showed no recurrent pseudoaneurysms.


CONCLUSIONS
For the treatment of iatrogenic femoral arterial pseudoaneurysms, thrombin injection with US guidance appears to be superior to compression repair.
Paulson
E K
EK
Department of Radiology, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710, USA.
Sheafor
D H
DH
Kliewer
M A
MA
Nelson
R C
RC
Eisenberg
L B
LB
Sebastian
M W
MW
Sketch
M H
MH
D000368:Aged; D017541:Aneurysm, False / Q000188:drug therapy* / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery / Q000293:injuries*; D005500:Follow-Up Studies; D005528:Foot / Q000098:blood supply; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007049:Iatrogenic Disease; D007269:Injections, Intra-Arterial; D015552:Injections, Intralesional; D008297:Male; D009339:Needles; D011312:Pressure; D011674:Pulse; D013917:Thrombin / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional
D006490:Hemostatics; D013917:Thrombin