A combined endovascular and ultrasound approach to femoral artery pseudoaneurysm injection following transcatheter aortic valve replacement (TAVR)

Iatrogenic femoral artery pseudoaneurysm (PSA) is a known complication of groin access for endovascular procedures. For cases refractory to ultrasound-guided thrombin injection, open repair risks blood loss during proximal and distal exposure, while covered stenting may be precluded by proximity to the femoral bifurcation. We report an 87-year-old hemodynamically unstable woman on vasopressor support and dual antithrombotic therapy who developed a 2.3-cm wide-necked left common femoral artery PSA during the post-TAVR course. After bedside ultrasound-guided thrombin injection failed, and with both open repair and covered stenting judged high risk, the PSA was treated using a hybrid approach combining endovascular balloon occlusion of the PSA neck with ultrasound-guided thrombin injection. The PSA was successfully excluded with preserved flow in the superficial and deep femoral arteries; 24-hour duplex confirmed a durable seal, and the patient remained complication-free at one year. In high-risk patients with wide-necked PSAs near the femoral bifurcation, this hybrid technique offers a lower-risk alternative to covered stenting or open surgery when standard thrombin injection fails.