ID:33 FC-D09-5 Successful percutaneous thrombin injection with balloon occlusion for a common femoral artery pseudoaneurysm following veno-arterial ECMO decannulation: a case report

Background: Femoral artery pseudoaneurysm is a potentially serious complication following peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) decannulation. Pseudoaneurysms are generally managed initially with standard manual compression or ultrasound-guided compression; however, when these approaches are unsuccessful, surgical repair or percutaneous thrombin injection with balloon occlusion (PTIBO) may be considered as alternative treatment options. To our knowledge, there have been no previous reports describing the use of PTIBO for pseudoaneurysms of the common femoral artery occurring after V-A ECMO decannulation. We therefore report this case. Case Course: A 74-year-old man with acute pulmonary embolism developed circulatory shock requiring V-A ECMO support. Systemic anticoagulation therapy was initiated, after which the patient’s hemodynamic status gradually stabilized, and ECMO was discontinued by manual compression on day 5. On day 7, the patient developed right groin pain at the arterial cannulation site, and imaging revealed a common femoral artery pseudoaneurysm measuring 34 × 21 × 32 mm. Ultrasound-guided compression was unsuccessful, and surgical repair was planned; however, the patient was a heavy smoker with COPD which could be high risk of respiratory complication following general anesthesia. Furthermore, operating room availability was temporarily limited. As an alternative to surgical repair, PTIBO using 5,000 units of thrombin was performed under local anesthesia, resulting in complete thrombosis of the pseudoaneurysm without any complications. Conclusion: PTIBO may be a feasible alternative treatment option for common femoral artery pseudoaneurysm following V-A ECMO decannulation.