People with heart disease and diseased leg arteries often undergo investigations and treatments that involve placing a needle into the main artery in the groin (endovascular procedures, for example diagnostic arteriogram, angioplasty, cardiac catheterization). One possible complication is the formation of a large swelling in the artery (a pseudoaneurysm) in the groin. This happens when the hole that the needle makes in the wall of the artery does not seal properly afterwards and blood collects, causing pain, swelling and bruising. Small pseudoaneurysms may clot spontaneously or surgery may be required. Less invasive treatment is now possible to stop the blood flow into the swelling. This involves sedation or analgesia to allow pressure to be placed over the puncture in the artery using a special mechanical device or a probe guided by ultrasound. Another option is injection of a clotting agent (thrombin) through the skin into the swelling.
The review authors searched the medical literature and found four randomised controlled trials. No new studies were included in this update. Application of pressure (compression) with a mechanical device for some 30 minutes caused clotting of the blood in the pseudoaneurysm in three-quarters of people (38 people aged between 40 and 85 years) within 24 hours. It made no difference if the probe was placed blindly or using ultrasound. A further study of 168 people found that compression caused clotting of the pseudoaneurysm in more than 90% of people at 24 hours; again, using ultrasound did not seem to make any difference. Injection of bovine thrombin appeared to be more effective that ultrasound-guided compression (in two studies, including 68 patients in total). There are, however, concerns about allergy to the thrombin and introduction of infectious agents, thought to be responsible for transmission of some degenerative diseases, as well as the possibility of causing a blood clot in the artery. No complications were reported in these studies apart from one deep vein thrombosis in the people treated with compression.