Balloon-assisted, ultrasound-guided percutaneous real-time thrombin injection, for the arteriovenous fistula pseudoaneurysm treatment

A pseudoaneurysm or false aneurysm is the consequence of a persistent blood leak caused generally by iatrogenic rupture of a vessel wall. The blood leak creates a new cavity delimited by surrounding tissues and allows blood flow to remain in continuity between this cavity and the vessel. In hemodialysis fistula, pseudoaneurysm generally results from repeated puncturing of the vein at the same site, leading to a bulging anatomical defect in the vein. Over the past few years, interventional radiological treatment has evolved and taken the place of surgery, with different kinds of percutaneous and endovascular treatment methods in pseudoaneurysm management. We reported a case report of successful treatment of arteriovenous fistula pseudoaneurysm with no-measurable neck. We performed ultrasound-guided percutaneous direct thrombin injection while an inflated balloon transiently obstructed flow out of the pseudoaneurysm, in order prevent non-target embolization.