Iatrogenic pseudoaneurysm PA is a classical complication of arterial percutaneous diagnostic angiography or interventional procedures which occurs in 0. Several therapeutic options have been described for the treatment of PAs, including surgery, ultrasound US -guided compression, coil embolization, stent-graft placement, or percutaneous thrombin injection.
US-guided compression is effective in a large proportion of patient but is associated with pain and discomfort 3 - 6. Thrombin injection is more effective but at risk of distal spillage in limb arteries and anaphylaxis. Furthermore, thrombin is quite expensive 5 - 7 and not available everywhere. Surgical interventions are more invasive but still have a role to play in case of failure of others techniques or in patients presenting with mass effect 8. N-butyl cyanoacrylate methacryloxy sulfolane NBCA-MS is a well-known glue comprising a proprietary comonomer as approved by the European Community for internal human use 9 , This synthetically derived glue shows rapid polymerization 1β5 s , but complete sealing occurs in approximately 5 min.
Lastly, the efficacy of glue is not affected by anticoagulant or antiplatelet therapy. Aytekin et al. However, the main risk of glue injection by direct puncture of a pulsating femoral mass is distal spillage of glue in the native artery through the pseudoaneurysmal neck Percutaneous US-guided glue injection into the sac with a balloon-assisted technique might be a good option in order to avoid distal spillage of glue in limb arteries.
In this study, we evaluated the safety, efficacy and utility of direct percutaneous injection of NBCA-MS with balloon occlusion for embolization of iatrogenic femoral PAs. Inclusion criteria were the presence of post-arterial catheterization iatrogenic PA at the femoral puncture site, whatever the size of the sac, after failed or contraindicated US-guided compression, or not. Due to the retrospective nature of this study, our Ethics Committee waived the requirement for informed patient consent.
For each lesion, the size of the aneurysmal sac was measured and the relationship to the artery from which it originated was noted. Pre-procedural US evaluation also included assessment of the neck length, PA chamber diameter, presence of arteriovenous fistula, and diameter of the native artery. Selective cannulation of the feeding artery was then performed. No heparin was given during the procedure. Then, injection of the mixture into the aneurysmal cavity was slowly performed under fluoroscopy guidance to visualize the glue distribution until complete filling of the sac Figure 1.
