# Percutaneous thrombin injection with intra-arterial balloon protection for iatrogenic puncture site pseudoaneurysm: a case series

## TL;DR

A new technique using thrombin injection and balloon protection successfully treats pseudoaneurysms after neurovascular procedures.

## Contribution

Combining thrombin injection with intra-arterial balloon protection is a novel approach for iatrogenic pseudoaneurysm treatment.

## Key findings

- Technical success was achieved in all cases with no complications.
- Parent artery patency was maintained and no recurrence was observed.
- The method was effective even in a patient with mild thrombocytopenia.

## Abstract

To evaluate the technical feasibility and preliminary outcomes of percutaneous thrombin injection with intra-arterial balloon protection to treat iatrogenic puncture site pseudoaneurysm (IPA) following neurovascular intervention.

The data of eight patients treated for IPAs following neurointerventions at a single institution between 2021 and 2024 were retrospectively reviewed. Three, two, and three patients were treated with ultrasound-guided thrombin injection (UGTI), covered stents, and thrombin injection with intra-arterial balloon protection, respectively. The patients treated with thrombin injection with intra-arterial balloon protection were included in the analysis. Two of these IPA cases involved the femoral artery, and one involved the brachial artery.

Technical success, defined as complete thrombosis of the pseudoaneurysm sac with preservation of the parent artery, was achieved in all cases. No procedure-related complications, such as distal embolism or parent artery occlusion, were observed. Antiplatelet therapy was continued without interruption, and the technique remained effective in one patient with mild thrombocytopenia. Follow-up ultrasonography at one day and one week confirmed the absence of recurrence and maintained patency of the parent artery. Furthermore, no symptoms of limb ischemia were observed immediately, one-day, three days, one-week and one-month clinical follow-up period.

Percutaneous thrombin injection combined with intra-arterial balloon protection is a technically feasible and potentially safe method for managing IPAs, particularly in patients requiring uninterrupted antiplatelet therapy. Use of the distal radial approach for balloon access may further reduce puncture-site complications. Larger, prospective studies are warranted to validate these findings and to compare this technique with established treatment modalities.