A 55-year-old woman has a 6 cm femoral artery pseudoaneurysm following cardiac catheterisation. It is symptomatic with local pain and compresses the femoral vein. What is the first-line treatment?

• A Surgical repair with vein patch angioplasty
• B Manual compression under ultrasound guidance
• C Observation with anticoagulation
• D Ultrasound-guided thrombin injection ✓

Explanation

Ultrasound-guided thrombin injection (UGTI) is the first-line treatment for iatrogenic femoral artery pseudoaneurysms, with success rates of >95%. It involves direct injection of thrombin into the pseudoaneurysm sac under ultrasound guidance, inducing thrombosis. Manual compression is only feasible for small pseudoaneurysms (<3 cm) without anticoagulation. Surgical repair is reserved for pseudoaneurysms with significant complications (infection, rapidly expanding, compressing neurovascular structures with failed UGTI). The 6 cm size and venous compression indicate treatment rather than observation.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.