Ultrasound-Guided Interventions for Femoral Artery Pseudoaneurysms

Femoral artery pseudoaneurysms arise when arterial puncture sites fail to seal, permitting blood to collect between the arterial wall layers and surrounding tissue. Most are iatrogenic, following diagnostic or therapeutic catheterisation, and present as a pulsatile groin mass, pain or local bruising. Duplex ultrasonography serves as the cornerstone for diagnosis, delineating the pseudoaneurysm sac, neck and flow characteristics. Traditional management encompassed prolonged manual compression or open surgical repair, but both carry significant discomfort, patient immobility and operative morbidity. Over the past three decades, ultrasound-guided percutaneous techniques have become the preferred first-line approach. These include direct injection of thrombogenic agents such as thrombin or fibrin glue into the sac, often followed by brief external compression to consolidate thrombosis. More recently, percutaneous direct-puncture embolisation with cyanoacrylate glue and combined ultrasound–fluoroscopy guidance have been introduced. Such minimally invasive interventions achieve rapid sac obliteration, allow same-day ambulation and reduce healthcare costs. Outcomes demonstrate high technical success rates, low complication profiles and minimal recurrence. The global rise in endovascular procedures has heightened the clinical relevance of these techniques, fostering standardised protocols and stimulating further innovation in image-guided haemostatic therapies.

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Ultrasound-Guided Interventions for Femoral Artery Pseudoaneurysms publication trend

The graph below shows the total number of articles in ultrasound-guided interventions for femoral artery pseudoaneurysms across all publications each year (not limited to Nature Index journals).

Technical terms

Femoral artery pseudoaneurysm: An extravascular blood collection communicating with the femoral artery through a disrupted arterial wall.

Percutaneous thrombin injection: Ultrasound-guided delivery of thrombin into a pseudoaneurysm sac to induce rapid clot formation.

Fibrin glue injection: Ultrasound-guided instillation of a fibrin-based haemostatic agent to seal the pseudoaneurysm cavity.

Percutaneous direct puncture embolisation: Image-guided access to a pseudoaneurysm followed by injection of adhesive embolic material.

Ultrasound-guided intervention: Use of real-time sonographic imaging to steer needles and monitor treatment delivery.

References

1. Treatment of iatrogenic femoral artery pseudoaneurysm with percutaneous thrombin injection. Journal of Vascular Surgery (1997).
2. Ultrasound-Guided Fibrin Glue Injection for Treatment of Iatrogenic Femoral Pseudoaneurysms. Vascular and Endovascular Surgery (2020).
3. Pseudoaneurysms embolization with glue via percutaneous direct puncture: a multicenter experience on 54 patients. CVIR Endovascular (2024).