Factors Associated With Initial Failure in Ultrasound-Guided Percutaneous Thrombin Injection for Iatrogenic Femoral Pseudoaneurysms.

Objective: This study aimed to evaluate factors associated with the initial failure of ultrasound-guided percutaneous thrombin injection in the treatment of iatrogenic femoral pseudoaneurysms (FPA).

Methods: A retrospective analysis was performed on 60 patients who developed iatrogenic FPA following transfemoral procedures at Zhongshan Hospital Xiamen University between January 2015 and December 2023. All patients received ultrasound-guided percutaneous thrombin injection. Fifty patients were successfully treated with a single injection (control group), while 10 patients required additional injections (experimental group). Baseline patient and pseudoaneurysm characteristics were compared between the two groups.

Results: Ultrasound-guided percutaneous thrombin injection successfully treated all pseudoaneurysms. No statistically significant differences were observed between the experimental and control groups in terms of sex, age, hypertension, diabetes mellitus, use of antiplatelet agents, parent artery involvement, maximum pseudoaneurysm diameter, ostium, or blood flow velocity at the ostium (p > 0.05). However, statistically significant differences were noted in aneurysm neck length and anticoagulant use (p < 0.05).

Conclusion: Aneurysm neck length and anticoagulant use were identified as factors influencing the effectiveness of initial ultrasound-guided percutaneous thrombin injection for iatrogenic FPA. For patients experiencing treatment failure, additional thrombin injections yielded satisfactory outcomes; surgical repair can even be avoided. Ultrasound-guided percutaneous thrombin injection is proposed as a safe, minimally invasive, and effective treatment option for iatrogenic pseudoaneurysm, valued for its simplicity and repeatability.