Duplex-guided thrombin injection for iatrogenic femoral artery pseudoaneurysm is effective even in anticoagulated patients

Background: The aim was to evaluate the efficacy and safety of percutaneous thrombin injection as an alternative non-operative method for treating postcatheterization femoral artery pseudoaneurysm in both anticoagulated and non-anticoagulated patients. Methods: Thirty consecutive patients with a femoral artery pseudoaneurysm secondary to radiological catheterization confirmed by duplex imaging were included. Thrombin 200-2000 units (1000 units/ml) in a titrating dose was injected into the centre of the cavity under duplex ultrasonographic guidance. Thrombosis was assessed in real time using B mode and colour flow. No sedation or anaesthesia was required during the procedure. The distal pulses and ankle pressures were evaluated before and immediately after the injection, to exclude propagation of thrombus into the femoral artery. Results: Successful rapid thrombosis of the false cavity was induced in all 30 patients. There were no immediate or mid-term procedure-related complications, or recurrences at 6 weeks. Eighteen patients were anticoagulated therapeutically at the time and following the procedure with either heparin or warfarin. Conclusion: Percutaneous thrombin injection is a simple, quick, painless, safe and effective technique, particularly in patients taking anticoagulants.