BRIEF RESEARCH REPORT article
Front. Radiol.
Sec. Interventional Radiology
This article is part of the Research TopicAdvances in Emergency Interventional Radiology: Techniques, Outcomes, and Future DirectionsView all 8 articles
Percutaneous Thrombin Injection With Intra-arterial Balloon Protection for Iatrogenic Puncture Site Pseudoaneurysm: a case series
Provisionally accepted
Chiu Shih Cheng1,2
Chang-Hsien Ou1,2*
Wan-Ching WCl109840@gmail.com Lin1,2Ho-Fai hfw007@changgung.org.tw Wong3- 1Eda Hospital, Kaohsiung, Taiwan
- 2I-Shou University, Kaohsiung, Taiwan
- 3Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Objective To evaluate the technical feasibility and preliminary outcomes of percutaneous thrombin injection with intra-arterial balloon protection to treat iatrogenic puncture site pseudoaneurysm (IPA) following neurovascular intervention. Methods The data of eight patients treated for IPAs following neurointerventions at a single institution between 2021 and 2024 were retrospectively reviewed. Three, two, and three patients were treated with ultrasound-guided thrombin injection (UGTI), covered stents, and thrombin injection with intra-arterial balloon protection, respectively. The patients treated with thrombin injection with intra-arterial balloon protection were included in the analysis. Two of these IPA cases involved the femoral artery, and one involved the brachial artery. Results Technical success, defined as complete thrombosis of the pseudoaneurysm sac with preservation of the parent artery, was achieved in all cases. No procedure-related complications, such as distal embolism or parent artery occlusion, were observed. Antiplatelet therapy was continued without interruption, and the technique remained effective in one patient with mild thrombocytopenia. Follow-up ultrasonography at one day and one week confirmed the absence of recurrence and maintained patency of the parent artery. Furthermore, no symptoms of limb ischemia were observed immediately, one-day, three days, one-week and one-month clinical follow-up period. Conclusion Percutaneous thrombin injection combined with intra-arterial balloon protection is a technically feasible and potentially safe method for managing IPAs, particularly in patients requiring uninterrupted antiplatelet therapy. Use of the distal radial approach for balloon access may further reduce puncture-site complications. Larger, prospective studies are warranted to validate these findings and to compare this technique with established treatment modalities.
Keywords: balloon, Injection, pseudoaneurysm, Thrombin, ultrasound
Received: 23 Oct 2025; Accepted: 22 Jan 2026.
Copyright: © 2026 Cheng, Ou, Lin and Wong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chang-Hsien Ou
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