Access-related pseudoaneurysm and complications of thrombin injection

Pseudoaneurysm formation is the most common complication following percutaneous femoral access. Currently, ultrasound remains the easiest and least invasive way of identifying and quantifying a pseudoaneurysm. The decision to intervene on a pseudoaneurysm is based upon size and a patient’s individual clinical situation, such as the need for anticoagulation. Those pseudoaneurysms that are larger than the 2–3 cm size threshold or pseudoaneurysms in patients who will need long-term anticoagulation are much less likely to resolve without some sort of intervention. Two cases presented here demonstrate basic technical aspects and decisions when using percutaneous injection of thrombin to induce thrombosis, perhaps the most popular technique currently employed today. Thrombin injection has been reported in multiple studies to have success rates of between 93 and 98 %.Complications associated with thrombin injection are infrequently reported with one meta-analysis publishing a complication rate of less than 1 % with the most frequent complication being distal embolization.