biostudies-literatureUnknown30(24)Sarwar MIatrogenic femoral artery pseudoaneurysms are a recognized complication after catheterization procedures. Although ultrasound-guided thrombin injection is the mainstay of treatment, pseudoaneurysms with wide necks or complex anatomy pose treatment challenges. We present a 6-case series in which a modified balloon-assisted thrombin injection (BATI) technique was employed using retrograde pedal or anterograde radial access in iatrogenic femoral artery pseudoaneurysms with wide-neck morphology or procedural risk factors. Distal access permitted simultaneous angiographic visualization and balloon occlusion during thrombin injection. All patients achieved complete thrombosis without complications or recurrence over 6 to 9 months of follow-up. Modified BATI via distal access offers a minimally invasive alternative for select complex pseudoaneurysms when traditional approaches are less favorable. Future studies are needed to evaluate long-term outcomes.JACC. Case reports104747https://www.ebi.ac.uk/biostudies/studies/S-EPMC12371418biostudies-literatureModified Balloon-Assisted Thrombin Injection via Distal Access for Complex Femoral Pseudoaneurysms.PMC12371418Sarwar MNarayanan MAHopper RHwang KAdedokun SDMoore KNfalseModified Balloon-Assisted Thrombin Injection via Distal Access for Complex Femoral Pseudoaneurysms.Iatrogenic femoral artery pseudoaneurysms are a recognized complication after catheterization procedures. Although ultrasound-guided thrombin injection is the mainstay of treatment, pseudoaneurysms with wide necks or complex anatomy pose treatment challenges. We present a 6-case series in which a modified balloon-assisted thrombin injection (BATI) technique was employed using retrograde pedal or anterograde radial access in iatrogenic femoral artery pseudoaneurysms with wide-neck morphology or procedural risk factors. Distal access permitted simultaneous angiographic visualization and balloon occlusion during thrombin injection. All patients achieved complete thrombosis without complications or recurrence over 6 to 9 months of follow-up. Modified BATI via distal access offers a minimally invasive alternative for select complex pseudoaneurysms when traditional approaches are less favorable. Future studies are needed to evaluate long-term outcomes.2025-01-01T00:00:00Z2025 Aug2026-04-08T07:10:57.591Z2026-04-07T23:31:05.95ZS-EPMC123714184084636110.1016/j.jaccas.2025.104747