Flow reduction aided thrombin injection for complex femoral pseudoaneurysms: Case series and review of the literature

• Published in: Annals of vascular surgery Vol. 46; pp. 367.e1 - 367.e6
• Main Authors: Menon, Nandakumar, MD, Drucker, Charles B., MD, Bhardwaj, Abhishek, MD, Kalsi, Richa, BS/BA, Crawford, Robert S., MD, Sarkar, Rajabrata, MD, PhD, Toursavadkohi, Shahab, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.01.2018
• Subjects: Aged; Aneurysm, False - diagnostic imaging; Aneurysm, False - drug therapy; Aneurysm, False - physiopathology; Balloon Occlusion; Computed Tomography Angiography; Female; Femoral Artery - diagnostic imaging; Femoral Artery - drug effects; Femoral Artery - physiopathology; Humans; Injections, Intra-Arterial; Male; Middle Aged; Regional Blood Flow; Surgery; Thrombin - administration & dosage; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Interventional; femoral artery; balloon occlusion; pseudoaneurysm; thrombin injection
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2017.06.032

Abstract We describe a series of 4 patients with complex femoral pseudoaneuryms including short, wide necks that were successfully managed with a combination of proximal endovascular balloon occlusion and percutaneous thrombin injection. Contralateral femoral access was used to place an occlusion balloon proximal to or across the lesion and thrombin was injected directly into the pseudoaneurysm under ultrasound guidance. All patients recovered from their procedures without incident and are free from recurrence at follow-up. Literature review found that balloon protection during thrombin injection is likely unnecessary for routine injection of pseudoaneurysms. However, this technique may have utility in the management of complex pseudoaneurysms, especially in a critically ill patient population with significant comorbidities.