Successful use of fibrin sealant in post-catherization pseudo-aneurysm of femoral artery after failure of compression attempt – A case study

A classic case study example of multidisciplinary approach where an expert radiologist superbly assisted cardiologist to do a rare difficult procedure is presented here. A 75 years old female referred for severe painful swelling in right groin showed a large soft tissue swelling filled with blood and communicating with femoral artery diagnosed as pseudo-aneurysm. Attempt was made to compress the neck which was not clearly defined, which failed. Hence, patient was taken for intra-lesion injection of fibrin sealant in Cath lab for guided usage of firbin sealant. The procedure was approached from left femoral artery using 6F long sheath and 6F Judkins JR catheter. A large 8x40 mm balloon was kept across the neck of pseudo-aneurysm and inflated to occlude the communication and simultaneously the fibrin sealant was injected into the pseudo-aneurysm under both ultrasonic and fluoroscopic guidance. Within few seconds, the whole pseudo-aneurysm was seen getting thrombosed with no flow from femoral artery as confirmed from post-procedure Doppler. The balloon was retrieved and check angiogram showed nicely flowing femoral artery with no signs of pseudo-aneurysm. The patient immediately improved with decrease in pain and swelling.