Iatrogenic pseudoaneurysms: comparison of treatment modalities, including duplex-guided thrombin injection.

The purpose of our study was to review the results of the three treatment modalities currently used at Charleston Area Medical Center (CAMC) for iatrogenic pseudoaneuryms. Retrospective records were reviewed of patients treated for pseudoaneurysms (PSA) from July 1, 2001 to June 30, 2002. In the 12-month period, 69 psedoaneurysms were treated with either ultrasound-guided compression (UGC), duplex-guided thrombin injection, or open operative repair. Twenty-seven of 47 femoral pseudoaneurysms (57%) were successfully treated with UGC. Twenty-six of 27 femoral pseudoaneurysms (96%) were succcessfully treated with DGTI, including nine after failed UGC. Seventeen patients were taken to the OR, 11 after failure of UGC and one patient after failure of both UGC and DGTI. Mean time for successful compression was 27 minutes. Mean operative time was 48 minutes and mean operative blood loss was 267cc. We conclude that ultrasound-guided thrombin injection should become the initial treatment of choice with operative therapy reserved for failed injection therapy.