Ipsilateral femoral vein compression: A contraindication to thrombin injection of femoral pseudoaneurysms

Abstract

Development of a femoral artery pseudoaneurysm occurs in 0.6% to 3.2% of interventional procedures. Nonsurgical treatment has consisted of ultrasound scan-directed compression and, more recently, direct thrombin injection into the pseudoaneurysm cavity to achieve thrombosis. Reported complications after thrombin injection are rare. We report two cases of femoral venous compression associated with pseudoaneurysm injection and review the literature. A 76-year-old man and an 86-year-old man both underwent thrombin injection of pseudoaneurysms compressing the ipsilateral common femoral vein. Both patients were diagnosed with deep venous thrombosis and subsequently needed surgical exploration for repair of the pseudoaneurysm and release of the venous compression. At exploration, both were found to have significant inflammation surrounding the femoral vessels, which made vessel exposure challenging. Because of the venous outflow obstruction involved in femoral pseudoaneurysms with secondary venous compression and the surgical difficulty caused by surrounding inflammation, avoidance of thrombin injection in favor of early surgical intervention is suggested.

Iatrogenic Pseudoaneurysm: An Uncommon Cause of Deep Vein Thrombosis

“…The patient denied immobilization, history of blood clots, and there was no hematoma or signs of infection or tumor-like osteochondromas on imaging. Only three case reports of DVT has been reported in the literature due to venous compression by pseudoaneurysm [ 8 - 10 ].…”

Complications of percutaneous thrombin injection in patients with postcatheterization femoral pseudoaneurysm

“…8,[17][18][19][20] Pulmonary embolism due to venous thrombosis has been reported in 0.2% of cases. 19,21,22 According to many investigators, the incidence of serious complications of TI is really negligible. 2,8,9,11,12,17,18,20 In the present study, the rate of serious complications was insignificant.…”

Mechanochemical tumescentless endovenous ablation: final results of the initial clinical trial

“…1,2 Most of these techniques involve percutaneous access, local anaesthesia, some form of ablation, and short operative times with relatively good safety and efficacy. The endothermal technologies require the use of tumescent anaesthesia prior to energy delivery and a generator to produce either laser or radiofrequency energy.…”