J Korean Soc Radiol.  2014 May;70(5):325-329. 10.3348/jksr.2014.70.5.325.

Balloon-Assisted Ultrasound-Guided Thrombin Injection of a Pseudoaneurysm in the Posterior Tibial Artery: A Case Report

• Lee TK
• Jeon YS
• Hong KC
• Cho SG
• Kim E

• KMID: 1941775
• DOI: http://doi.org/10.3348/jksr.2014.70.5.325

Abstract

An ultrasound-guided direct injection of thrombin is currently the first choice of treatment for the postcatheterization pseudoaneurysm, mainly in the femoral artery. A pseudoaneurysm in the posterior tibial artery is very rare, so there are not enough reports about proper treatment yet. We report a case of a balloon-assisted injection of thrombin under ultrasonography-guidance to manage a pseudoaneurysm in the posterior tibial artery and concurrently to prevent a distal artery embolization.

MeSH Terms

Aneurysm, False*
Arteries
Femoral Artery
Thrombin*
Tibial Arteries*
Thrombin

Figure

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  Fig. 1 Angiogram shows contrast outpouching lesion (arrow), consistent with pseudoaneurysm in distal right posterior tibial artery.

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  Fig. 2 Color Doppler ultrasound shows typical swirling mosaic pattern of color flow (arrow) in pseudoaneurysm sac.

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  Fig. 3 21-G Chiba needle (arrow) was inserted in the pseudoaneurysm under ultrasound guidance after occlusion of flow with 2.5 mm balloon (arrowhead).

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  Fig. 4 Color Doppler ultrasound shows disappearance of abnormal color flow and the thrombus completely filling the pseudoaneurysm.

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  Fig. 5 Immediate postprocedure angiogram shows disappearance of pseudoaneurysm in distal right posterior tibial artery.

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  Fig. 6 Color Doppler ultrasound in logitudinal axis shows good arterial flow without pseudoaneurysm or hematoma after 3 months.

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