A Tiny Injection, a Big Save: Thrombin for Ruptured Femoral Pseudoaneurysm

Abstract

Background: Femoral artery pseudoaneurysm is a well-recognized complication following diagnostic and therapeutic endovascular procedures. Although most pseudoaneurysms remain clinically stable, rupture is uncommon and may result in significant hemorrhage, rapid decline in hemoglobin, and hemodynamic compromise. Surgical repair has traditionally been considered the treatment of choice in ruptured cases; however, ultrasound-guided percutaneous thrombin injection has emerged as a minimally invasive alternative in selected patients.

Case Presentation: A 73-year-old female presented with pain and bluish discoloration of the left lower limb. Computed tomography angiography demonstrated significant atherosclerotic disease with approximately 60–70% luminal narrowing of the left common iliac artery. The patient underwent successful left common iliac artery angioplasty with deployment of a 6 × 57 mm stent through left femoral arterial access. Three to four days after the procedure, she developed discoloration and swelling at the femoral access site associated with a substantial fall in hemoglobin from 11.6 g/dL to 6.4 g/dL. Ultrasonography of the left proximal thigh revealed a multilobulated pseudoaneurysm measuring approximately 1.2 × 2 cm arising from the common femoral artery with turbulent flow on color Doppler and an adjacent heterogeneous collection suggestive of a contained ruptured pseudoaneurysm. Considering the patient's advanced age and comorbidities, ultrasound-guided percutaneous thrombin injection was performed. Complete thrombosis of the pseudoaneurysm was achieved immediately, with no residual flow on follow-up ultrasonography.

Conclusion: Ruptured femoral artery pseudoaneurysm is a rare but potentially life-threatening complication following endovascular intervention. This case highlights that ultrasound-guided percutaneous thrombin injection can be a safe, effective, and minimally invasive treatment option in carefully selected patients with contained rupture, potentially avoiding the need for surgical intervention.