How to perform ultrasound-assisted thrombin injection for closure of iatrogenic femoral pseudoaneurysm.

A 52-year-old female underwent elective diagnostic cardiac catheterization for a chest pain syndrome and an abnormal exercise stress test. Standard Seldinger technique with a 6 French femoral sheath was used. After femoral sheath removal, hemostasis was achieved by direct pressure on the groin for 20 minutes, followed by a pressure dressing. She had been taking aspirin (325 mg/day). One week later the patient returned with progressive right groin discomfort, accompanied by a 3-cm palpable pulsatile mass. Ultrasound imaging of the right groin revealed a narrow necked femoral pseudoaneurysm (FPN) (Fig. 1). The patient subsequently underwent ultrasound-guided percutaneous injection of the FPN with 200 units thrombin (Thrombin-JMI, GenTrac, Inc., Middleton, WI) over 1 minute. The FPN was noted to thrombose during injection (Fig. 2). A FPN is a contained rupture of all three vessel layers. It is bounded by surrounding tissues, whereas a true aneurysm is bounded by vessel wall. The communication (“neck”) between