Percutaneous Thrombin Injection: An Alternative Therapy for Iatrogenic Carotid Artery Pseudoaneurysms

INTRODUCTION: Carotid artery pseudoaneurysm is a rare but potentially morbid complication of central venous catheter insertion. Traditionally managed by open surgical or endovascular repair, this article describes a case that used percutaneous thrombin injection. Delivered at the point of care under ultrasound guidance, it offers a less invasive and less resource dependent approach where conventional therapies are unsuccessful. CASE REPORT: A 63 year old man re-presented to hospital with a right common carotid artery pseudoaneurysm following internal jugular vein catheterisation for a staged transcatheter aortic valve implantation. An attempt was made at coil occlusion by the neuro-interventional radiology team, but this was unsuccessful given inability to pass a delivery catheter to the pseudoaneurysm tract in the setting of a tortuous and calcified proximal circulation. Subsequently, direct percutaneous thrombin injection, administered under ultrasound guidance was undertaken as an alternative approach. Complete thrombosis was achieved with no complications and the patient was discharged on day three of admission. DISCUSSION: While percutaneous thrombin injection is commonly used in the treatment of femoral pseudoaneurysms, there remains a paucity of evidence regarding its use in the management of carotid pseudoaneurysms. This case demonstrates its effectiveness in treating this complication. Percutaneous thrombin injection may offer a highly effective treatment option for carotid pseudoaneurysm, particularly where more conventional therapies have been unsuccessful or are relatively contraindicated.