History: A 64-year old woman was admitted because of unstable angina pectoris. The coronary angiogram revealed two-vessel coronary disease with predominantly subtotal stenosis of the right coronary artery, which was treated by primary coronary stenting. The post-interventional clinical course after closure of the right femoral artery was complicated by the development of a complex pseudoaneurysm: its ultrasound-guided compression was unsuccessful.
Investigations: The clinical findings included a marked superficial hematoma in the right groin without any evidence of an abscess, confirmed by color duplex ultrasonography.
Treatment and course: 24 hours later a successful percutaneous ultrasound-guided thrombin injection of the pseudoaneurysm was performed without any problems regarding the injection into the aneurysm. A small area within the aneurysm remained perfused and was treated by additional ultrasound-guided compression. A few minutes after the compression complete thrombosis of the right superficial femoral artery occurred with acute critical ischemia of the right leg, probably due to leakage of thrombin into the femoral artery at the sheath puncture. The immediate therapy, including interventional recanalization of the right femoral superficial artery and subsequent fibrinolysis, produced a complete reperfusion of the right femoral superficial and popliteal artery. The fibrinolytic therapy resolved the thrombosis of the pseudoaneurysm. The remainder of the perfused pseudoaneurysm was treated surgically after one week without problems.
Conclusion: This case demonstrates a so far rarely published complication of the displacement of thrombin from an intervention ally treated pseudoaneurysm into the right superficial femoral artery through a broad compound channel after ultrasound-guided compression.