Ultrasound-guided injection of thrombin for treatment of pseudoaneurysm
PROCEDURE: Ultrasound-guided injection of thrombin for treatment of pseudoaneurysm of the right femoral artery.
INDICATIONS: 55-year-old woman who was admitted to hospital with acute to subacute myocarditis and cardiogenic shock. She underwent heart catheterization and intraaortic balloon counterpulsation and has had persistent swelling and pain in her right groin inferior to the catheter insertion site. Ultrasound evaluation revealed a large trilobed pseudoaneurysm.
OPERATION: Informed consent was obtained. The patient was placed supine on her bed and the site was prepped and draped in standard sterile fashion. She received a total of 2 mg of intravenous Versed (midazolam hydrochloride) and 3 mg of intravenous morphine for pain relief and sedation. Color-flow and gray scale images were obtained of the pseudoaneurysm under sterile conditions. Under direct ultrasound guidance, a #23gauge needle was inserted into each of the three chambers of the pseudoaneurysm and intracameral position was documented by injection of saline. A total of 4,000 units of thrombin was injected in 1,000- to 2,000-unit aliquots with complete thrombosis of the pseudoaneurysm under direct imaging guidance. The patient tolerated her procedure well and no complications were identified. The pedal pulses were 3+ and bounding following the procedure and there was no further evidence of color-flow or pulsation in the pseudoaneurysm.