Treatment of pseudoaneurism of the femoral artery with local injection of thrombin

Background

Vascular complications following arterial punctures for diagnostic or therapeutic procedures, or both, have been reported in several series with an incidence ranging from 0.7 to 9%. The most frequent complications are local hematomas, arteriovenous fistulas, and pseudoaneurisms (PA).

Objective

To compare the efficacy of the surgical treatment and use of solutions with lower thrombin concentrations (150-200 U/ml), assessing the hospitalization time.

Case report

A 54 year-old white Brazilian male, admitted to the Hospital Pró-Cardíaco, RJ, on 22 February 2003 for closure of a PA in the right inguinal region (after percutaneous angioplasty).

Materials and methods

The Vivid 3 vascular echocardiographic and ultrasound device (General Electric) equipped with a 10 MHz linear probe and pulsed color Doppler was used. Bovine thrombin (component of BERIPLAST^® P; Aventis) in a 100 U/ml solution was used. A color duplex scan of the lower limbs was performed for diagnostic confirmation of the PA, identification of the vessel related to the PA, measurements required by the procedure, and assessment of the arterial anatomy of both lower limbs. Ultrasound-guided puncture of the PA was performed, and contrast medium (agitated 0.9% saline solution) was injected to show the exact position of the needle tip inside the PA, which should be as far as possible from the PA neck, avoiding thrombin embolism. Then, the thrombin solution was slowly injected until closure of the PA (i.e. cessation of the systodiastolic flow through the PA neck), assessed on ultrasound. The amount of solution required for this was 0.5 ml, corresponding to 50 U thrombin. The duplex scan was repeated with the patient resting for 1 hour, and again on hospital discharge, 24 hours after the procedure, which confirmed the good result of the technique used.

Conclusion

The injection of a low dose of thrombin guided by ultrasound and aided by contrast medium use was effective in closing the PA. The hospitalization time was reduced even in patients undergoing anticoagulation.