PMC10417016_01
(a, b) USG shows a large pseudoaneurysm (PSA) with to and fro flow on color Doppler within the aneurysmal sac. Eccentric echogenic thrombus (white star) is noted inside the PSA; (c) Doppler showing jet-like flow from SFA into the PSA sac; (d) PSA neck measures 2.2 mm.
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Detailed ultrasonography (US) revealed an oval-shaped anechoic cystic lesion (5.4 x 3.2 x 2.5 cm) in the right groin with peripheral eccentric hematoma (Fig. 1a, 1b). The neck of the PSA measured 2.2 mm in diameter (Fig. 1b-1d).
(a, b) Angiographic run shows a contrast-filled oval-shaped pseudoaneurysm (curved black arrow) arising from SFA as indicated by jet-like neck (thin black arrows); (c) 2 LP needles (21G) were placed within PSA (white arrow c, d), and then 8 mm balloon (thick black arrow) was inflated across the neck of PSA; (d) USG-guided thrombin injection showing thrombosis of PSA sac (thick white arrow); (e) Post-embolization DSA shows nonopacification of PSA with normal opacification of SFA
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Digital subtraction angiography (DSA) through a 5F multipurpose (MPA) catheter demonstrated a large oval-shaped contrast-filled pseudoaneurysm arising from the superficial femoral artery (SFA) just distal to the bifurcation of the common femoral artery (Fig. 2a, 2b). Temporary balloon inflation for 30 seconds showed remarkable reduction in intra-aneurysmal flow on Doppler imaging (Fig. 2c). Two 21G lumbar puncture (LP) needles were inserted into the PSA near the dome under the USG guidance, with the tip of one needle towards the right and the other towards the left side of the PSA (Fig. 2d). USG guidance, 1.5 ml of reconstituted thrombin solution was administered slowly through each LP needle simultaneously using 2 ml syringes (Fig. 2e). USG following 8 minutes of thrombin injection showed thrombosis of most of the PSA except for a small area near the PSA neck showing persistent flow. No embolism was observed in the SFA or distal arteries of the right lower extremity (Fig. 2f).
(a, b) Follow-up USG showing thrombosed PSA with no flow on Doppler imaging. Thrombosed PSA sac showing dependent echogenic retracted clot (white arrow) and nondependent anechoic serum.
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