Imaging-guided percutaneous thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms

  • Wendy L. EhieliEmail author
  • Erol Bozdogan
  • Gemini Janas
  • Tracy A. Jaffe
  • Chad M. Miller
  • Mustafa R. Bashir
  • Brian C. Allen
Interventional Radiology



To evaluate factors that may affect successful ultrasound-guided percutaneous thrombin injection of iatrogenic femoral artery pseudoaneurysms (PSA).

Materials and methods

This was an IRB-approved, HIPAA-compliant retrospective study of 326 consecutive subjects (138 males, 188 females; mean age 68 years, range 18–95) who underwent thrombin injection for treatment of femoral PSA; follow-up ultrasound was available in 145 subjects. The number of PSA lobes and dimensions, pre-procedure laboratory values (international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count), and concomitant anticoagulation therapy were recorded.


Technical success was achieved in 98.2% (320/326) of subjects. Primary effectiveness (complete thrombosis at 24 h) was achieved in 74.5% (108/145). Twenty-five subjects underwent repeat thrombin injection, successful in 21 subjects, for a total effectiveness rate of 97.0% (129/133). No imaging factor was associated with technique failure, including number of lobes (p = 0.898), largest dimension (p = 0.344), or volume (p = 0.697). No statistically significant difference in pre-procedure INR, aPTT, or platelet count was found between subjects with CT and those with IT (p > 0.138). Anticoagulation therapy was associated with incomplete thrombosis (35.5% [38/107] for CT vs. 63.9% [23/26] for IT; p = 0.002).


Imaging-guided percutaneous thrombin injection has high technical success and effectiveness rates for the treatment of iatrogenic femoral artery PSA. Anticoagulation therapy was the only factor associated with incomplete thrombosis.


Pseudoaneurysm Percutaneous thrombin injection Ultrasound Anticoagulation 


Compliance with ethical standards

Conflict of interest

Wendy Ehieli, Erol Bozdogan, Gemini Janas, Tracy Jaffe, Chad Miller, and Brian Allen have declare that they have no conflict of interest. Mustafa Bashir: Research support, Siemens Healthcare, GE Healthcare, NGM Bio, TaiwanJ Pharma, Madrigal Pharmaceuticals.

IRB statement

This retrospective study was approved by our institutional review board and was compliant with the Health Insurance Portability and Accountability Act. The requirement for written informed consent was waived.


  1. 1.
    Katzenschlager R, Ugurluoglu A, Ahmadi A et al (1995) Incidence of pseudoaneurysm after diagnostic and therapeutic angiography. Radiology 195:463-466CrossRefGoogle Scholar
  2. 2.
    Etemad-Rezai R, Peck DJ (2003) Ultrasound-guided thrombin injection of femoral artery pseudoaneurysms. Can Assoc Radiol J 54:118-120Google Scholar
  3. 3.
    Brophy DP, Sheiman RG, Amatulle P, Akbari CM (2000) Iatrogenic Femoral Pseudoaneurysms: Thrombin Injection after Failed US-guided Compression. Radiology 214:278-282CrossRefGoogle Scholar
  4. 4.
    Tisi PV, Callam MJ (2013) Treatment for femoral pseudoaneurysms. Cochrane Database Syst Rev. Google Scholar
  5. 5.
    Saad NE, Saad WE, Davies MG, Waldman DL, Fultz PJ, Rubens DJ (2005) Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics : a review publication of the Radiological Society of North America, Inc 25 Suppl 1:S173-189Google Scholar
  6. 6.
    Kontopodis N, Tsetis D, Tavlas E, Dedes A, Ioannou CV (2016) Ultrasound Guided Compression Versus Ultrasound Guided Thrombin Injection for the Treatment of Post-Catheterization Femoral Pseudoaneurysms: Systematic Review and Meta-Analysis of Comparative Studies. European Journal of Vascular and Endovascular Surgery 51:815-823CrossRefGoogle Scholar
  7. 7.
    Perler BA (1993) Surgical treatment of femoral pseudoaneurysm following cardiac catheterization. Cardiovasc Surg 1:118-121Google Scholar
  8. 8.
    Ricci MA, Trevisani GT, Pilcher DB (1994) Vascular complications of cardiac catheterization. Am J Surg 167:375-378CrossRefGoogle Scholar
  9. 9.
    Lumsden AB, Miller JM, Kosinski AS et al (1994) A prospective evaluation of surgically treated groin complications following percutaneous cardiac procedures. The American surgeon 60:132-137Google Scholar
  10. 10.
    Thalhammer C, Kirchherr AS, Uhlich F, Waigand J, Gross CM (2000) Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation of endovascular covered stents. Radiology 214:127-131CrossRefGoogle Scholar
  11. 11.
    Fellmeth BD, Roberts AC, Bookstein JJ et al (1991) Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression. Radiology 178:671-675CrossRefGoogle Scholar
  12. 12.
    Paulson EK, Nelson RC, Mayes CE, Sheafor DH, Sketch MH, Jr., Kliewer MA (2001) Sonographically guided thrombin injection of iatrogenic femoral pseudoaneurysms: further experience of a single institution. AJR Am J Roentgenol 177:309-316CrossRefGoogle Scholar
  13. 13.
    Pezzullo JA, Dupuy DE, Cronan JJ (2000) Percutaneous injection of thrombin for the treatment of pseudoaneurysms after catheterization: an alternative to sonographically guided compression. AJR Am J Roentgenol 175:1035-1040CrossRefGoogle Scholar
  14. 14.
    Kang SS, Labropoulos N, Mansour MA, Baker WH (1998) Percutaneous ultrasound guided thrombin injection: a new method for treating postcatheterization femoral pseudoaneurysms. J Vasc Surg 27:1032-1038CrossRefGoogle Scholar
  15. 15.
    Paulson EK, Sheafor DH, Kliewer MA et al (2000) Treatment of iatrogenic femoral arterial pseudoaneurysms: comparison of US-guided thrombin injection with compression repair. Radiology 215:403-408CrossRefGoogle Scholar
  16. 16.
    Morgan R, Belli AM (2003) Current treatment methods for postcatheterization pseudoaneurysms. Journal of vascular and interventional radiology : JVIR 14:697-710CrossRefGoogle Scholar
  17. 17.
    Esterson YB, Pellerito JS (2017) Recurrence of Thrombin-Injected Pseudoaneurysms Under Ultrasound Guidance: A 10-Year Retrospective Analysis. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 36:1617-1624CrossRefGoogle Scholar
  18. 18.
    Liau CS, Ho FM, Chen MF, Lee YT (1997) Treatment of iatrogenic femoral artery pseudoaneurysm with percutaneous thrombin injection. J Vasc Surg 26:18-23CrossRefGoogle Scholar
  19. 19.
    Krueger K, Zaehringer M, Strohe D, Stuetzer H, Boecker J, Lackner K (2005) Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology 236:1104-1110CrossRefGoogle Scholar
  20. 20.
    Shah KJ, Halaharvi DR, Franz RW, Jenkins Ii J (2011) Treatment of Iatrogenic Pseudoaneurysms Using Ultrasound-Guided Thrombin Injection over a 5-Year Period. Int J Angiol 20:235-242CrossRefGoogle Scholar
  21. 21.
    Vlachou PA, Karkos CD, Bains S, McCarthy MJ, Fishwick G, Bolia A (2011) Percutaneous ultrasound-guided thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms. European journal of radiology 77:172-174CrossRefGoogle Scholar
  22. 22.
    Chen DH, Sammel AM, Jain P, Jepson NS (2015) Cardiologist operated ultrasound guided thrombin injection as a safe and efficacious first line treatment for iatrogenic femoral artery pseudoaneurysms. Heart Lung Circ 24:165-172CrossRefGoogle Scholar
  23. 23.
    Olsen DM, Rodriguez JA, Vranic M, Ramaiah V, Ravi R, Diethrich EB (2002) A prospective study of ultrasound scan-guided thrombin injection of femoral pseudoaneurysm: a trend toward minimal medication. J Vasc Surg 36:779-782CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyDuke University Medical CenterDurhamUSA

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