Low-dose thrombin injection to treat iatrogenic femoral artery pseudoaneurysms

Treatment of iatrogenic femoral artery pseudoaneurysms with thrombin injection has been reported as an efficacious and safe procedure. The major risk of this procedure is distal limb ischemia from thrombosis, resulting from thrombin escape. The cumulative average dose of thrombin reported in the literature is approximately 1100 U per patient. Minimizing the thrombin dose may reduce the risks of the procedure. This study reports our experience with low-dose thrombin injection for the treatment of pseudoaneurysms.

Twenty-three patients with 26 postcatheterization femoral pseudoaneurysms were administered thrombin injection with color-flow Doppler sonographic guidance. Pseudoaneurysm volume ranged from 1 to 41 cm(3) with an average of 6.7 cm(3) and a median of 4 cm(3). Two patients received therapeutic doses of IV heparin for anticoagulation. When possible, the neck of the pseudoaneurysm was occluded during the injection to promote stagnation and prevent thrombin leakage. Sonographic follow-up was routinely performed after 24 hr.

An average dose of 192 U of thrombin was used (range, 50-450 U), and time to coagulation ranged from 10 to 60 sec. All 26 pseudoaneurysms were successfully thrombosed, although one required repeated treatment because of recanalization noted at 1-day follow-up. There were no complications.

Doses of thrombin at an average of fivefold lower than previously reported were effective in the treatment of 26 iatrogenic femoral pseudoaneurysms, even in the presence of anticoagulation. This experience shows that a much smaller dose of a potentially dangerous medication can achieve the same efficacy as previously used higher doses.