Modified Balloon-Assisted Thrombin Injection via Distal Access for Complex Femoral Pseudoaneurysms

Iatrogenic femoral artery pseudoaneurysms are a recognized complication after catheterization procedures. Although ultrasound-guided thrombin injection is the mainstay of treatment, pseudoaneurysms with wide necks or complex anatomy pose treatment challenges.

We present a 6-case series in which a modified balloon-assisted thrombin injection (BATI) technique was employed using retrograde pedal or anterograde radial access in iatrogenic femoral artery pseudoaneurysms with wide-neck morphology or procedural risk factors. Distal access permitted simultaneous angiographic visualization and balloon occlusion during thrombin injection. All patients achieved complete thrombosis without complications or recurrence over 6 to 9 months of follow-up.

Modified BATI via distal access offers a minimally invasive alternative for select complex pseudoaneurysms when traditional approaches are less favorable. Future studies are needed to evaluate long-term outcomes.