Thrombin-induced thrombosis models for ultrasound-guided thrombin injection of femoral artery pseudoaneurysms

Abstract

Pseudoaneurysm forms as a sac from arterial wall damage due to percutaneous procedures and poses a high risk of rupture if untreated. Ultrasound-guided thrombin injection (UGTI) is the most common minimally invasive treatment, which specifically involves the interaction between injected thrombin and plasma fibrinogen. This study presents the development of a thrombin-induced thrombosis model within a computational fluid dynamics framework to simulate thrombus formation in plasma. The model was applied to pseudoaneurysms with complex geometries, including sac diameters greater than 20 mm, neck widths exceeding 10 mm, or neck lengths shorter than 5 mm. By varying injection parameters such as location, duration, and dosage, we evaluated procedural outcomes based on two clinical indicators: technical success and treatment success. The analysis revealed that injection times shorter than 5 s were associated with lower treatment success rates, indicating reduced procedural safety. In contrast, injection durations of 8 s or longer led to improved technical and treatment outcomes. Additionally, treatment success was more consistent when the thrombin dose approached 500 IU. However, in pseudoaneurysms with neck widths over 10 mm, increasing the thrombin dose caused excessive fibrin leakage outside the sac. To ensure both the safety and effectiveness of UGTI procedures, it is clinically recommended to maintain an injection time of at least 8 s, limit the thrombin dose to 500 IU or less, and target the center of the pseudoaneurysm sac for injection.