title: Sonographically guided thrombin injection of iatrogenic femoral pseudoaneurysms: further experience of a single institution.
abstract: OBJECTIVE
  In September 1998, we began to treat iatrogenic femoral pseudoaneurysms with direct thrombin injection under sonographic guidance. Our purpose was to determine the success and complication rate of this technique.
  
  
  METHODS
  We treated 114 consecutive patients who had iatrogenic femoral pseudoaneurysms using direct thrombin injection. A 22-gauge spinal needle was placed into the pseudoaneurysm lumen with sonographic guidance, and bovine or human thrombin (mean dose, 306 U; range, 50--1600 U) was injected under continuous color Doppler sonographic visualization. Distal pulses were monitored. Patient demographics, clinical variables, and pseudoaneurysm characteristics were collected.
  
  
  RESULTS
  One hundred three (90%) of 114 patients had pseudoaneurysm thrombosis after the first procedure. Of the remaining 11 patients who required a second procedure 1 day later, thrombosis occurred in seven (64%) of 11. Thus, the overall success rate was 96% (110/114). Of the patients who required one injection, the mean thrombosis time was 12 sec (range, 3--90 sec). Three (3%) of 114 patients required conscious sedation. Of the patients with successful thrombosis, 24-hr follow-up sonograms showed no recurrent pseudoaneurysm. Four patients (4%) had potential complications: a "blue toe" 15 hr after the thrombin injection that resolved spontaneously, a groin abscess, leg ischemia that resolved spontaneously after 4 hr, and crampy buttock pain that resolved spontaneously.
  
  
  CONCLUSIONS
  For the treatment of iatrogenic femoral pseudoaneurysms, thrombin injection under sonographic guidance is a quick and effective method of therapy. Failures and complications are infrequent. At our institution, sonographically guided thrombin injection has replaced compression repair.
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Paulson
authors.forename: R C
authors.initials: RC
authors.lastname: Nelson
authors.forename: C E
authors.initials: CE
authors.lastname: Mayes
authors.forename: D H
authors.initials: DH
authors.lastname: Sheafor
authors.forename: M H
authors.initials: MH
authors.lastname: Sketch
authors.forename: M A
authors.initials: MA
authors.lastname: Kliewer
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000188:drug therapy* / Q000209:etiology; D000818:Animals; D006328:Cardiac Catheterization / Q000009:adverse effects; D002417:Cattle; D005260:Female; D005263:Femoral Artery; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use*; D018084:Ultrasonography, Interventional
chemical_list: D006490:Hemostatics; D013917:Thrombin