Successful direct thrombin injection of a femoral artery pseudoaneurysm in an anticoagulated patient with a mechanical mitral valve.

Femoral pseudoaneurysm is a complication of cardiac catheterization and may be related to the use of anticoagulants, antiplatelet agents, larger diameter sheaths and prolonged duration of sheath insertion. The treatment ranges from direct compression with or without direct thrombin injection to surgical repair. The present report describes a unique scenario of postcardiac catheterization femoral artery pseudoaneursym in a patient with a pre-existing mechanical mitral valve requiring anticoagulation. The potential systemic effects of thrombin made the patient reluctant to undergo treatment and made thrombin administration a challenging proposition. The present report suggests that thrombin injection for treating femoral pseudoaneursym in patients with mechanical heart valves on chronic anticoagulation can be performed safely.