Treatment of arterial pseudoaneurysms with percutaneous ultrasound-guided thrombin injection

Background: The pseudoaneurysms or false aneurysms are one of the most common complications after arterial invasive manipulation. Different methods of treatment have been described, such as surgical repair, ultrasound-guided compression and endovascular procedures. Ultrasound-guided thrombin injection has shown efficacy, safety and low cost, and, in some cases, the procedure is considered the treatment of choice. Preliminary results are presented. Methods: Design: Case series. We studied adult patients with iatrogenic arterial pseudoaneurysms demonstrated clinically and corroborated with ultrasound. We describe the technique used for the management of the arterial pseudoaneurysms by ultrasound-guided thrombin application, as well as complications and follow-up. Results: Twelve patients were included with a mean age of 63 years (SD 12.4), 33% were male and 67% female. Associated comorbid states were hypertension 83%, 50% diabetes, obesity 66%. All pseudoaneurysms were located in the femoral artery (2:1 right/left ratio). The mean size of the pseudoaneurysm was 48.2 mm SD 11.9, (range of 30 to 65 mm) by 44.3 mm SD 9.3, (range 20 to 53 mm). The average neck diameter was 2.2 mm SD 0.54 (range of 1.5 to 3 mm). Eleven cases were unilobulated (87.5%), and one bilobulated (12.5%). All reported arterial integrity with complete occlusion after one thrombin application without recurrence and morbidity after 90 days of follow up. Conclusions: In our study we obtained a 100% of thrombosis without pseudoaneurysm recurrence or complications. However a longer follow-up time and more number of cases are required to confirm these results.