The treatment of iatrogenic spurious aneurysm of the femoral artery by direct thrombin injection

Abstract

After percutaneous catheter introduction a false aneurysm occasionally develops at the site of puncture. This has been treated either surgically or, more recently, by ultrasound-guided compression. A new method has been tried in which the false aneurysm is thrombosed by injecting thrombin into it. In 29 patients thrombin was injected directly into the false aneurysm of the femoral artery, caused by catheter introduction into the vessel. Puncture of the aneurysm and injection of the thrombin solution was performed with continuous duplex-sonographic monitoring. The patients' age ranged from 42 to 88 years (mean 71 +/- 12 years). The false aneurysm had occurred after diagnostic catheterization (n = 5), balloon dilatation of peripheral vessels (n = 5) or balloon catheter dilatation of the coronary arteries (n = 19) with catheters size 5 F (n = 4), 6 F (n = 6), 8 F (n = 16) or 9-13 F (n = 3). The catheterization had been done 1-30 days previously (mean 5.3 +/- 6.9 days). The diameter of the aneurysm ranged from 2.1 to 5 cm (mean 3.5 +/- 0.9 cm). The aneurysms thrombosed within seconds after injection of 0.075 to 1.5 ml (mean 0.4 +/- 0.4 ml). All interventions were successful and without complications. Any resulting haematoma regressed within a few days to a few weeks and none recurred. In two patients a persisting haematoma had later to be removed surgically, and in another patient a second aneurysm was removed surgically without prior thrombin injection. A false aneurysm of the femoral artery caused by percutaneous catheterization can be successfully thrombosed by direct thrombin injection.