Unsuccessful Thrombin Injection for Right Femoral Artery Pseudoaneurysm: A Case Report

A 33-year-old man was brought to the emergency department after sustaining multiple traumas. The interventional radiology team performed vascular embolization via a 6 Fr sheath inserted into the right common femoral artery due to suspected bleeding from the duodenum. The man underwent multidisciplinary management. On day 3 after injury, contrast-enhanced computed tomography (CT) revealed a pseudoaneurysm in the right common femoral artery, the radiology team opted for thrombin injection therapy, and the patient was monitored. No swelling was initially observed. However, repeat contrast-enhanced CT demonstrated a pseudoaneurysm on postinjury day 9, indicating that thrombin treatment had failed. Vascular surgery was considered, and emergency surgical intervention was performed on the same day. A pseudoaneurysm and a 6 Fr sheath puncture site were identified through a right inguinal incision, and hemostasis was achieved. The postoperative course was uneventful, and the patient was transferred for rehabilitation on postoperative day 19 following pseudoaneurysm repair. This case involved the development of a femoral artery pseudoaneurysm following endovascular treatment for multiple traumas. Although the interventional radiology team performed a local thrombin injection, the treatment ultimately failed, necessitating vascular surgery intervention. The patient underwent open surgical repair without complications. With the increasing use of local thrombin injection for pseudoaneurysms, careful post-treatment monitoring is essential, and surgical intervention should be considered at an appropriate time if necessary.