Ultrasound-guided thrombin-gelatin injection is effective for the treatment of iatrogenic femoral artery pseudoaneurysms: initial results

To describe the technique of ultrasound (US)-guided percutaneous thrombin-gelatin injection for the treatment of femoral artery pseudoaneurysms (FAPs).FAPs are a possible complication from percutaneous angiographic procedures. US-guided thrombin injection is currently the preferential therapeutic option, limited by a low risk of potentially catastrophic femoral thrombosis; transluminal injection of collagen is another effective and safe option, although a more invasive one; surgical repair is associated with significant comorbidity. We hypothesized that US-guided combined thrombin and gelatin injection (UG-TGI) would also be effective while minimizing the risk of limb thrombosis.Review of the results, complications and length of hospital admission after the injection into the FAP sac of combined human-origin thrombin and bovine-origin gelatin matrix (FloSeal(®), Baxter), under direct US-guidance.We treated 13 patients (mean age 64 ± 9.46 years, 38% male), who developed a FAP following a percutaneous procedure: isolated coronariography in five (38%); angioplasty in four (31%); other cardiac procedures in four (31%). Immediate success was obtained in all (100%) patients, assessed by US; no allergic reactions, local infection, or embolic events occurred on 30-day follow-up. Median (interquartile range) admission time after the UG-TGI was 2 days (1.25-2.0); median time of total admission was 8 days (6.5-16.25).In this small study, UG-TGI for the treatment of FAP was feasible and had short-term effectiveness, without a learning curve effect. Despite the need for further experience, a trial comparing different therapies for FAP should include this procedure.