Post-Coronary Catheterization Pseudoaneurysm

Middle aged male with a recent coronary artery catheterization has complaints of pain and swelling at the puncture site in the right groin.

A right lower extremity angiogram was performed from the left. The above images of the right common femoral artery demonstrate an approximately 2-cm pseudoaneurysm (arrow).

 

First-line treatment for catheter induced pseudoaneurysms is graded ultrasound-guided compression. In this case, compression was not successful. The next line of treatment consists of thrombin injection. Injection of thrombin can be done using ultrasound alone. The requesting service had concerns about non-target thrombosis (embolization of thrombin during injection) and requested balloon occlusion of the neck of the pseudoaneurysm. (We had no such concerns, but decided to humor them anyway.) The above unsubtracted image demonstrates an angioplasty balloon in place, covering the neck of the pseudoaneurysm, just prior to thrombin injection. The needle (arrows) was placed using ultrasound guidance.

 

A completion angiogram demonstrates complete thrombosis of the pseudoaneurysm.