Skip to main content

Scintigraphic assessment of arterial embolism at mixed thrombin and technetium 99m injection therapy for femoral pseudoaneurysms



Clinically evident arterial thrombosis is rare following thrombin injection therapy for femoral pseudoaneurysm. However, it is unclear to what extent injected thrombin may pass to the ipsilateral lower limb arteries.


To assess if technetium 99m injected at the time of thrombin injection for femoral artery pseudoaneurysm therapy passes into the adjacent lower limb arteries.


This was a prospective trial with institutional review board approval. Four consecutive patients with common femoral pseudoaneurysms and failed manual compression were enrolled. Under real-time colour flow doppler ultrasound, a mixture of 1000 IU thrombin and approximately 200 MBq technetium 99m was injected in 0.1-mL doses into the pseudoaneurysm until thrombosis occurred. Gamma camera imaging of the syringe before injection, the injected groin after thrombosis and the syringe after injection were performed. Analysis of the gamma camera information was performed to determine the amount of technetium 99m deposited in the arterial tree.


All the procedures were technically successful. A mean of 33% (range 3–50%; SD 21) of the administered technetium 99m dose was deposited in the arterial circulation during pseudoaneurysm therapy. No clinically evident arterial thrombosis was identified.


Technetium 99m is routinely deposited in the arterial circulation following injection of a mixture of thrombin and technetium for therapy of common femoral artery pseudoaneurysms. This suggests that arterial passage of thrombin is more common than clinically evident.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Messina LM, Brothers TE, Kliewer MA et al (1991) Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: interventional versus diagnostic procedures. J Vasc Surg 13:593–600

    CAS  Article  Google Scholar 

  2. Toursarkissian B, Allen BT, Petrinec D, Thompson RW, Rubin BG, Reilly JM, Anderson CB, Flye MW, Sicard GA (1997) Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. J Vasc Surg 25:803–808

    CAS  Article  Google Scholar 

  3. Coley BD, Roberts AC, Fellmeth BD, Valji K, Bookstein JJ, Hye RJ (1995) Postangiographic femoral artery pseudoaneurysms: further experience with US-guided compression repair. Radiology 194:307–311

    CAS  Article  Google Scholar 

  4. Kobeiter H, Lapeyre M, Becquemin JP, Mathieu D, Melliere D, Desgranges P (2002) Percutaneous coil embolization of postcatheterization arterial femoral pseudoaneurysms. J Vasc Surg 36(1):127–131

    Article  Google Scholar 

  5. Thalhammer C, Kircherr AS, Uhlich F, Waigand J, Gross CM (2000) Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation of endovascular covered stents. Radiology 214:127–131

    CAS  Article  Google Scholar 

  6. Friedman SG, Pellerito JS, Scher L et al (2002) Ultrasound-guided thrombin injection is the treatment of choice for femoral pseudoaneurysms. Arch Surg 137(4):462–464.

    CAS  Article  PubMed  Google Scholar 

  7. 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 177:309–316

    CAS  Article  Google Scholar 

  8. Lennox AF, Delis KT, Szendro G, Griffin MB, Nicolaides AN, Cheshire NJ (2000) Duplex-guided thrombin injection of artery pseudoaneurysm is effective even in anticoagulated patients. Br J Surg 87:796–801

    CAS  Article  Google Scholar 

  9. Khoury M, Rebecca A, Greene K, Rama K, Colaiuta E, Flynn L, Berg R (2002) Duplex scanning-guided thrombin injection for the treatment of iatrogenic pseudoaneurysms. J Vasc Surg 35:517–521

    Article  Google Scholar 

  10. Friedman SG, Pellento JS, Scher L et al (2002) Ultrasound-guided thrombin injection is the treatment of choice for femoral pseudoaneurysms. Arch Surg 137:462–464

    CAS  Article  Google Scholar 

  11. Kang SS, Labropoulos N, Mansour A et al (2000) Expanding indications for ultrasound-guided thrombin injection of pseudoaneurysms. J Vasc Surg 31:289–298

    CAS  Article  Google Scholar 

  12. La Perna L, Olin JW, Goines D et al (2000) Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. Circulation 102:2391–2395

    Article  Google Scholar 

  13. Weinmann EE, Chayen D, Kobzantzev ZV, Zaretsky M, Bass A (2002) Treatment of postcatheterization false aneurysms: ultrasound-guided compression vs. ultrasound-guided thrombin injection. Eur J Vasc Endovasc Surg 23:68–72

    CAS  Article  Google Scholar 

  14. Owen RJT, Haslam PJ, Elliot ST, Rose JDG, Loose HW (2000) Percutaneous ablation of peripheral pseudoaneurysms using thrombin: a simple and effective solution. Cardiovasc Intervent Radiol 23:441–446

    CAS  Article  Google Scholar 

  15. Mohler ER III, Mitchell ME, Carpenter JP, Strandness DE Jr, Jaff MR, Beckman JA, Gerhard-Herman M (2001) Therapeutic thrombin injection of pseudoaneurysms: a multicenter experience. Vasc Med 6:241–244

    Article  Google Scholar 

  16. Morrison SI, Obrand DA, Steinmetz OK, Montreuil B (2000) Treatment of femoral artery pseudoaneurysms with percutaneous thrombin injection. Ann Vasc Surg 14:634–639

    CAS  Article  Google Scholar 

  17. Conroy RM, Lyons KP, Kuperus JH, Juler GL, Joy I, Pribram HFW (1978) New technique for localization of therapeutic emboli using radionuclide labeling. Am J Roentgenol 130:523–528

    CAS  Article  Google Scholar 

  18. duCret RP, Adkins MC, Hunter DW et al (1990) Therapeutic embolization: enhanced radiolabeled monitoring. Radiology 177:571–575

    CAS  Article  Google Scholar 

  19. Endert G, Penzel E, Ritter H, Schumann E (1983) 133Xe labeling of tissue adhesives for catheter embolization. Rofo 138:79–81

    CAS  Article  Google Scholar 

  20. Kruger K, Zahringer M, Sohngen FD et al (2003) Femoral pseudoaneurysm: management with percutaneous thrombin injections - success rates and effects on systemic coagulation. Radiology 226:452–458

    Article  Google Scholar 

  21. Wong D, Tanaka T, Mishkin F, Lee T (1979) In vitro assessment of Tc-99m labeled bovine thrombin and streptokinase-activated human plasmin: concise communication. J Nucl Med 20:967–972

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to John G. Murray.

Ethics declarations

Ethical approval

“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Mater Misericordiae University Hospital, reference number 1/378/892) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards”.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cantwell, C.P., Murray, O.M. & Murray, J.G. Scintigraphic assessment of arterial embolism at mixed thrombin and technetium 99m injection therapy for femoral pseudoaneurysms. Ir J Med Sci 189, 133–137 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Femoral artery thrombin embolism
  • Femoral pseudoaneurysm therapy
  • Scintigraphy pseudoaneurysm
  • Thrombin injection pseudoaneurysm