Ultrasound guided thrombin injection for treating iatrogenic femoral artery pseudoaneurysms: a review focusing upon sonographic diagnosis and treatment

Abstract

An exponential increase in the number of diagnostic and therapeutic endovascular interventions, as well as in the use of antiplatelet and anticoagulation therapy, has raised the incidence of iatrogenic femoral artery pseudoaneurysms. Historically accepted methods (spontaneous closure in non-anticoagulated patients, ultrasound-guided compression repair, surgical repair) have been introduced in the past as first line treatments, while more novel alternatives have also been suggested to replace them. The purpose of this review is to demonstrate the significance of femoral artery pseudoaneurysm formation, to evaluate the appropriate diagnosis with ultrasound (US) and to present US-guided thrombin injection (UGTI) as the most advocated method of treatment over surgical repair and US-guided compression repair. Complications of UGTI are also discussed, an algorithm for using this procedure is suggested and alternative treatments are reviewed.