How is a small femoral artery pseudoaneurysm typically treated?

• A. Ultrasound-guided thrombin injection
• B. Open surgical repair for all cases
• C. Observation only
• D. Endovascular stent graft placement

Answer: (A)

Small femoral artery pseudoaneurysm after catheterization is best treated with ultrasound-guided thrombin injection because it directly induces rapid thrombosis of the aneurysm sac while preserving the main artery. Under real-time ultrasound, a small amount of thrombin is injected into the sac, causing it to clot quickly. The feeding neck to the artery remains intact, but flow into the sac stops, allowing the pseudoaneurysm to thrombose and then resolve with time. This approach is minimally invasive, often performed with local anesthesia, and has a high success rate with rapid recovery.

Open surgical repair is more invasive and reserved for cases like rupture, infection, or failure of less invasive methods. Observation alone isn’t reliable for most progressive pseudoaneurysms. Endovascular stent grafts are used for different scenarios, such as wide-neck or complex injuries or when preserving arterial patency is difficult, but they aren’t the first-line choice for a small, uncomplicated femoral pseudoaneurysm.