Ultrasound-Guided Intrasac Thrombin Injection for Iatrogenic Femoral Artery Pseudoaneurysm: A Systematic Review

ObjectiveTo systematically evaluate the efficacy and safety of ultrasound-guided thrombin injection (UGTI) for the treatment of femoral pseudoaneurysms, analyze the technical factors influencing treatment success, and provide evidence-based guidance for clinical practice.MethodsA systematic search of the PubMed database was conducted to identify clinical studies on UGTI for femoral pseudoaneurysms. Original studies with clearly defined efficacy outcome measures were included. Key data, including technical success rates and complication rates, were extracted. Technical details of the procedure (eg, thrombin concentration, injection dose, and neck management strategies) were summarized and analyzed.ResultsMultiple relevant studies were included. The technical success rate of UGTI for femoral pseudoaneurysms exceeded 90%. The commonly used thrombin concentration ranged from 100 to 1000 U/mL, with a single total injection dose typically between 150 and 750 U (equivalent to an injection volume of 1-5 mL). The overall complication rate was approximately 2%, with distal thromboembolism being the most frequent. For wide-necked or anatomically complex pseudoaneurysms, balloon-assisted UGTI further enhanced treatment safety by effectively preventing limb ischemia resulting from thrombin extravasation. Compared to traditional treatment methods, UGTI demonstrated significant advantages in terms of procedure time, patient comfort, and therapeutic stability.ConclusionUGTI for the treatment of femoral pseudoaneurysms offers the benefits of being a simple, rapid, minimally invasive procedure with definitive efficacy and a low recurrence rate. It has become the first-line treatment option, replacing traditional compression therapy and surgery. Strict adherence to indications, precise ultrasound guidance, and individualized thrombin dosing are crucial for successful treatment. For complex cases, balloon-assisted techniques serve as an important adjunctive strategy.