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(Circulation. 1999;100:e39-e41.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Treatment of an Iatrogenic Femoral Artery Pseudoaneurysm With Percutaneous Duplex-Guided Injection of Thrombin

A. F. Lennox, MSc, FRACS; M. B. Griffin, MSc; N. J. Cheshire, MD, FRCS; N. C. Peters, MD, MRCP; R. A. Foale, MD, MRCP; A. N. Nicolaides, MS, FRCS

From Irvine Laboratory (A.F.L., M.B.G., A.N.N.), Regional Vascular Unit (N.J.C.), and Department of Cardiology (N.C.P., R.A.F.), Imperial College School of Medicine, St Mary's Hospital, London, UK.

Correspondence to Dr A.F. Lennox, Irvine Laboratory for Cardiovascular Investigation and Research, 10th Floor QEQM Wing, St Mary's Hospital, Praed Street, London W2 1NY, UK. E-mail a.lennox@ic.ac.uk

	Introduction

 
A65-year-old woman was referred to the vascular laboratory after coronary angiography and stent insertion via an 8F right femoral artery sheath. The patient received ticlopidine 500 mg after the procedure. A large pulsatile mass with a diffuse hematoma developed several hours after removal of the sheath from the groin, and a 4.2-cm false aneurysm arising from the common femoral artery was confirmed on duplex ultrasound scanning (ATL HDI 3000, 4- to 7-MHz probe), as demonstrated in Figure 1. Attempts at ultrasound-guided compression as an initial treatment were limited by excessive pain and were eventually abandoned.

View larger version (126K): [in this window] [in a new window]   Figure 1. Duplex ultrasound image of pseudoaneurysm, demonstrating arterial flow through a long, narrow neck arising from defect in femoral artery and turbulent color flow into cavity.

Percutaneous injection of thrombin (1000 US U/mL, GenTrac Inc) into the center of the false aneurysm cavity was performed under duplex guidance with a 2-mL syringe and a 22-gauge needle. After accurate placement of the needle into the pseudoaneurysm cavity (Figures 2 and 3), a total of 750 U (0.75 mL) was slowly injected over 10 seconds, during which rapid thrombosis of blood flow within the cavity occurred, as demonstrated in Figure 4. Pulsatility from within the cavity ceased, and the patient was discharged from hospital the following day after repeat scanning had confirmed absence of any arterial flow within the cavity. At subsequent review, the patient remained asymptomatic, with a small resolving hematoma.

View larger version (136K): [in this window] [in a new window]   Figure 2. With color flow removed, exact position of needle tip . . . [Full Text of this Article]