Thromboembolism complicating thrombin injection of femoral artery pseudoaneurysm: management with intraarterial thrombolysis.

Ultrasound (US)-guided compression of pseudoaneurysms is being rapidly replaced by US-guided percutaneous treatment with thrombin injection because of the less intensive nature of this procedure. Thromboembolism after percutaneous treatment with thrombin injection is rare and has been described in brachial artery pseudoaneurysms. These were managed with intravenous administration of heparin and surgical thrombectomy. In this report, the authors describe thromboembolic complication of thrombin injection after treatment of a femoral artery pseudoaneurysm. This was managed by intraarterial thrombolysis with use of recombinant tissue plasminogen activator (rt-PA) with resolution of all major occlusive changes. A lower dose of thrombin injection and frequent postprocedural monitoring of distal pulses is recommended.