Circulation. 1999;100:e39-e41
(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{at}ic.ac.uk
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Introduction
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 Top
 Introduction
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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.
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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.
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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.
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Figure 2. With color flow removed, exact position of needle
tip can be identified at all times during procedure, because a small
amount of echogenic thrombus forms at needle tip when thrombin comes
into contact with blood, helping to guide needle placement.
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Figure 3. With needle in position, color flow during
injection of thrombin confirms acute development of thrombus within
sac.
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Figure 4. Power Doppler image of patent native femoral
vessels (CFA indicates common femoral artery; SFA, superficial femoral
artery; and PFA, profunda femoris artery) and absence of flow after
successful thrombin injection into pseudoaneurysm cavity.
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The incidence of iatrogenic pseudoaneurysms after femoral
artery catheterization is reported to be up to 1% to
2% and has increased over recent years as a result of the use of
larger-size catheters for interventional procedures. The treatment of
this complication has traditionally been surgical repair or, more
recently, ultrasound-guided compression, but
percutaneous injection of thrombin can be completed in
several minutes, has the advantage of avoiding surgical intervention or
the pain associated with ultrasound-guided compression, and can be
performed effectively in patients who have received
anticoagulation.
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Footnotes
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister,
Jr, MD, Chief, Department of Pathology, St Luke's Episcopal
Hospital and Texas Heart Institute, and Clinical Professor of
Pathology, University of Texas Medical School and Baylor College
of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
