Percutaneous thrombin injection for treatment of iatrogenic femoral artery pseudoaneurysms: a case for caution.
The case of a patient who developed a femoral artery pseudoaneurysm following cardiac catheterization is described. After 2 failed attempts of ultrasound-guided compression repair, the patient underwent percutaneous thrombin injection with, beside of complete closure of the pseudoaneurysm, a severe limb ischemia due to distal thrombin migration with consecutive clot formation finally resulting in thigh amputation of the affected leg. Indications, advantages, and disadvantages of various options for the treatment of iatrogenic femoral artery pseudoaneurysms (vascular surgery, ultrasound-guided compression, percutaneous thrombin injection, and other nonsurgical treatment modalities), as well as risk factors for distal migration of liquid thrombin after percutaneous injection, are discussed in this report.
Ohlow
Marc-Alexander
MA
Klinik für Kardiologie, Zentralklinik, Bad Berka, Germany. m.ohlow.kar@zentralklinik-bad-berka.de
Secknus
Maria-Anna
MA
von Korn
Hubertus
H
Weiss
Reginald
R
Lauer
Bernward
B
D000368:Aged; D000671:Amputation, Surgical; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D007269:Injections, Intra-Arterial; D007511:Ischemia / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D008297:Male; D018579:Patient Selection; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D013917:Thrombin / Q000008:administration & dosage / Q000009:adverse effects*; D014463:Ultrasonography
D006490:Hemostatics; D013917:Thrombin