Percutaneous thrombin injection of carotid artery pseudoaneurysm

Abstract

Purpose: To report the successful treatment of a carotid artery pseudoaneurysm by percutaneous thrombin injection.

Case report: A 71-year-old man with end-stage renal failure presented with acute left ventricular failure. The right common carotid artery (CCA) was punctured during attempted jugular line insertion, and he developed a large pseudoaneurysm connected to the CCA by a long, narrow neck. Ultrasound-guided compression was unsuccessful, so another technique was attempted. An occlusion balloon was inflated in the CCA at the neck of the aneurysm to avoid distal embolization, and 250 units of human thrombin were injected into the sac percutaneously; thrombosis was instantaneous. There were no procedural complications, and repeat ultrasound at 3 months showed resolution of the hematoma and no residual pseudoaneurysm. There were no neurological complications.

Conclusions: Percutaneous thrombin injection may be a new and successful method of treating carotid artery pseudoaneurysms.