Recurrence of Femoral Pseudoaneurysm after Ultrasound-Guided Thrombin Injection

Abstract

Although pseudoaneurysm is a rare recurrence after ultrasound-guided thrombin injection, it can occur. We report a patient who, despite complete pseudoaneurysm thrombosis, visualized on ultrasound, repeatedly reformed his femoral pseudoaneurysm. For the femoral pseudoaneurysm to recur, continued leakage via the arterial defect was necessary, as the result of an inability to seal the pseudoaneurysm defect. In addition significant thrombolysis of the already-formed thrombus needed to occur. In this patient, the powerful antiplatelet agents and Von Willebrand factor dysfunction could have easily prevented the sealing of the common femoral artery defect. In addition, thrombolysis would likely be enhanced by the increased levels of plasmin that are associated with end-stage renal disease patients on hemodialysis. Ultrasound-guided thrombus injection of iatrogenic femoral pseudoaneurysms is generally safe, effective, and well tolerated. Even with visualization of complete thrombosis, there remains a small group of patients that are at risk for recurrence and that ultimately require surgical repair. This group of patients could easily be missed unless strict adherence to follow-up screening protocols is followed.