Fluoroscopy-Guided Balloon Thrombin Safely Treats Complex CFA Pseudoaneurysms: A Case Report
According to a recent case report, a new fluoroscopy-based balloon occlusion technique combined with thrombin injections proved successful in treating complex pseudoaneurysms of the common femoral artery without complications, and can therefore serve as an alternative method when standard therapies fail. Common femoral artery pseudoaneurysm is one of the complications, which commonly occurs following interventional arterial puncture, and can generally be treated by means of prolonged actual compression and ultrasonography-assisted thrombin injections. Prolonged actual compression can often cause marked pain and can have high rates of failure, whereas ultrasonography-assisted thrombin injections can sometimes prove tricky and ineffective, especially when there are complex pseudoaneurysms. The study was published in the Medicine journal by Liu Z. and colleagues.
A therapeutic dilemma exists with post-interventional CFA pseudoaneurysms with complex lesions or with failure of conventional therapies. Common compression therapy may be uncomfortable for the patient and does not guarantee optimal thrombosis. Thrombin injection with US guidance has certain drawbacks in complex anatomy due to visibility issues and the possible migration of the thrombin agent. All the above issues emphasize the need to develop novel approaches that can accurately occlude the pseudoaneurysms with minimal patient risks.
A patient presented with multiple pseudo-aneurysms of the CFA following an interventional arterial puncture. On clinical examination and imaging studies, there was confirmation of multiple pseudo-aneurysm sacs arising from the common femoral artery. In relation to lesion complexity, in order to avoid discomfort and high failure risk of compression therapy, limitations of ultrasound-guided thrombin injection were considered. An alternative minimally invasive strategy was thus broached.
The patient was treated with X-ray fluoroscopy-guided balloon blocking combined with the injection of thrombin. In this regard, under fluoroscopic guidance, the balloon catheter is positioned to temporarily occlude arterial inflow to the pseudoaneurysm necks. Thrombin is then injected to induce controlled thrombosis of the pseudoaneurysm lumens. Such fluoroscopy allowed one to take a look at the real-time flow of the contrasting agent and to determine with great precision the occlusion of pseudoaneurysm, increasing the accuracy and safety of the procedure.
The procedure was performed successfully without any complications in the operating and postoperative period. The thrombosis and occlusion of the pseudoaneurysm cavities were confirmed by the immediate fluoroscope image, and at the 1-month imaging follow-up, the occlusion was confirmed without any signs of recurrence. In this case report, occlusion of multiple CFA pseudoaneurysms was realized at 100%, using fluoroscopy-guided balloon blocking plus thrombin injection. There were zero procedural complications, and complete occlusion was maintained at 1-month follow-up.
The combined procedure of balloon occlusion under fluoroscopy and thrombin injection seems to be a safe and effective method in the treatment of complex cases of common femoral artery pseudoaneurysms, especially those that are resistant to compression or ultrasound-guided thrombin injection techniques. The procedure can be considered as a supplement for other treatment modalities available.
Reference:
Liu, Zhengli MDa; Xia, Yuqing MDb; Kong, Jie PhDa; Gu, Jianping PhDa; Xia, Meiqi MDb,*. Fluoroscopy-guided balloon blocking combined with thrombin injection for pseudoaneurysm of the common femoral artery. Medicine 104(52):p e46690, December 26, 2025. | DOI: 10.1097/MD.0000000000046690
