Ultrasound-guided percutaneous thrombin injection following iatrogenic femoral artery pseudoaneurysm: patient selection and perspectives

Ultrasound-guided percutaneous thrombin injection (UGTI) following iatrogenic femoral artery pseudoaneurysms has been the standard of care as first-line treatment at many institutions since its initial description by Liau et al in 1997. UGTI underwent rapid adoption given its significant advantages to patients including shorter procedure times, decreased discomfort, lower rates of recurrence, and the avoidance of surgical intervention in appropriate cases. Despite the availability of less-invasive approaches, through numerous head-to-head studies, UGTI has demonstrated clear benefit over ultrasound-guided compression in the treatment of iatrogenic femoral artery pseudoaneurysms. Although newer interventions such as percutaneous coil embolization have attracted attention for their superior ability to manage those patients with high-level anticoagulation or allergies to thrombin, at this time they do not provide an equal alternative to thrombin injection. In this review, we focus on issues related to the selection of patients who benefit from UGTI for the treatment of iatrogenic pseudoaneurysms.