title: Ultrasound-guided thrombin injection for the treatment of iatrogenic pseudoaneurysm of the femoral artery.
abstract: BACKGROUND
  Pseudoaneurysm occurring after catheterization of the femoral artery is associated with significant morbidity. Percutaneous ultrasound-guided thrombin injection has recently emerged as a potential first-line therapy.
  
  
  OBJECTIVE
  To evaluate the efficacy of this treatment in eight patients with iatrogenic femoral artery pseudoaneurysm.
  
  
  METHODS
  After attempted treatment with external compression had failed, eight patients with iatrogenic femoral artery pseudoaneurysm were treated with thrombin injection. Treatment performed between 2 and 9 days following arterial puncture. The study group comprised seven males and one female ranging in age from 23 to 89 years (median 70). Seven had undergone cardiac catheterization with or without intervention, and five were receiving antiplatelet and/or anticoagulant drugs. Arterial pseudoaneurysm resulted from femoral vein catheterization in one patient. Using a sterile technique and real-time Doppler ultrasound guidance, a dilute solution of bovine thrombin (average dose 250 units, range 100-600), was slowly injected directly into the pseudoaneurysm until cessation of flow was seen. Patients were allowed to walk within 2 hours of the procedure and were followed up clinically and by color Doppler ultrasound during the admission.
  
  
  RESULTS
  Cardiac catheterization had been inadvertently performed via the superficial or profunda femoris arteries in four of the eight patients. Thrombin injection was initially successful in all eight patients without complication. Thrombosis occurred immediately in every case. Early recanalization of pseudoaneurysm occurred in one patient despite repeat thrombin injection and attempted ultrasound-guided compression. He eventually required surgical repair. The final success rate was 87.5% (7/8).
  
  
  CONCLUSIONS
  Faulty puncture technique is an important risk factor for the development of post-catheterization femoral artery pseudoaneurysm. Ultrasound-guided thrombin injection is a safe, rapid, well-tolerated, inexpensive and successful therapy. If initial external compression with a sandbag fails to result in thrombosis of the pseudoaneurysm then thrombin injection should be considered as first-line therapy. If unsuccessful, it does not preclude the use of alternative treatment modalities. Further study is necessary to assess the long-term effects of thrombin injection.
authors.affiliation: Department of Radiology, Hadassah University Hospital, Jerusalem, Israel. blumy2k@yahoo.co.uk
authors.forename: A I
authors.initials: AI
authors.lastname: Bloom
authors.forename: T
authors.initials: T
authors.lastname: Sasson
authors.forename: A
authors.initials: A
authors.lastname: Verstandig
authors.forename: Y G
authors.initials: YG
authors.lastname: Wolf
authors.forename: H
authors.initials: H
authors.lastname: Anner
authors.forename: Y
authors.initials: Y
authors.lastname: Berlatzky
authors.forename: I
authors.initials: I
authors.lastname: Akopnick
authors.forename: C
authors.initials: C
authors.lastname: Lotan
authors.forename: R
authors.initials: R
authors.lastname: Lederman
authors.forename: P D
authors.initials: PD
authors.lastname: Lebensart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000188:drug therapy* / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use*; D014463:Ultrasonography
chemical_list: D006490:Hemostatics; D013917:Thrombin