title: Ultrasound-guided thrombin-gelatin injection is effective for the treatment of iatrogenic femoral artery pseudoaneurysms: initial results.
abstract: OBJECTIVE
  To describe the technique of ultrasound (US)-guided percutaneous thrombin-gelatin injection for the treatment of femoral artery pseudoaneurysms (FAPs).
  
  
  BACKGROUND
  FAPs are a possible complication from percutaneous angiographic procedures. US-guided thrombin injection is currently the preferential therapeutic option, limited by a low risk of potentially catastrophic femoral thrombosis; transluminal injection of collagen is another effective and safe option, although a more invasive one; surgical repair is associated with significant comorbidity. We hypothesized that US-guided combined thrombin and gelatin injection (UG-TGI) would also be effective while minimizing the risk of limb thrombosis.
  
  
  METHODS
  Review of the results, complications and length of hospital admission after the injection into the FAP sac of combined human-origin thrombin and bovine-origin gelatin matrix (FloSeal(®), Baxter), under direct US-guidance.
  
  
  RESULTS
  We treated 13 patients (mean age 64 ± 9.46 years, 38% male), who developed a FAP following a percutaneous procedure: isolated coronariography in five (38%); angioplasty in four (31%); other cardiac procedures in four (31%). Immediate success was obtained in all (100%) patients, assessed by US; no allergic reactions, local infection, or embolic events occurred on 30-day follow-up. Median (interquartile range) admission time after the UG-TGI was 2 days (1.25-2.0); median time of total admission was 8 days (6.5-16.25).
  
  
  CONCLUSIONS
  In this small study, UG-TGI for the treatment of FAP was feasible and had short-term effectiveness, without a learning curve effect. Despite the need for further experience, a trial comparing different therapies for FAP should include this procedure.
authors.affiliation: Department of Cardiology, Santa Cruz Hospital, Lisbon, Portugal. c.miguel.santos@gmail.com
authors.forename: Miguel Borges
authors.initials: MB
authors.lastname: Santos
authors.forename: Sergio
authors.initials: S
authors.lastname: Silva
authors.forename: Vitor
authors.initials: V
authors.lastname: Bettencourt
authors.forename: Rui Campante
authors.initials: RC
authors.lastname: Teles
authors.forename: Manuel Sousa
authors.initials: MS
authors.lastname: Almeida
authors.forename: Duarte
authors.initials: D
authors.lastname: Medeiros
authors.forename: Jose Aniceto
authors.initials: JA
authors.lastname: Silva
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000187:drug effects*; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007049:Iatrogenic Disease; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011677:Punctures; D013917:Thrombin / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional
chemical_list: C411004:FloSeal Matrix; D013917:Thrombin