During the period of 3 years, we analyzed 46 patients who underwent the catheterization of the femoral artery due to therapeutic endovascular procedures. A written informed consent was obtained from all the patients, and approved by the Institutional Review Board. Patients were clinically examined, and color Doppler examination was performed (with a 5–10 MHz linear vascular transducer, Aloka SSD-3500, Aloka, Tokyo, Japan). Before the procedure, pulse oximeter was placed on the great toe of the affected limb, and saturation was recorded before, during, and 10 min after the procedure. Pulse oximetry was used to evaluate oxygen saturation in distal parts of the affected limb. If there was a sudden fall in saturation during the procedure, we assumed possible thrombin escape into the circulation. We used VAS scale (visual analog pain scale) to evaluate pain during the compression. If VAS Scale result was more than 4, before or during the procedure, we used analgesia/sedation regime (sufentanil 5–10 μg i.v./midazolam 1–3 mg i.v.). In all the cases, the tract of the PSA was treated for 20 min with USGC repair. In the patients where USGC repair failed, we used UGTI. Ultrasound-guided puncture with 25 G spinal needle was performed using free hand, in-plane technique. In the case of multisacular PSA, thrombin was injected into the sac closer to the artery, which usually results in thrombosis of all the other sacs. First operator analyzes blood flow through femoral artery and PSA sac, using real time US Doppler. When the position of the PSA sac, femoral artery, and neck of the PSA are confirmed, first operator performs US-guided puncture of the PSA. The whole length of the needle has to be visible during the procedure, and after precise visualization of the tip of the needle in the center of the PSA (Fig. 1), assistant operator performs manual compression of the ipsilateral iliac artery for 30 s (Fig. 2). During this period of time first operator has to be aware of the needle position and blood flow cessation in the PSA sac. After the initial 30 s first operator injects human thrombin during the next 30 s. Total amount of human thrombin [500–1,500 IU (1–3 ml) Baxter AG TISSEEL Lyo, Human Thrombin] is guided on real-time US imaging, simultaneously monitoring the formation of a stable thrombus inside the PSA sac. Before injection color Doppler has to be off to clearly see, in real time US, the formation of the thrombus inside the PSA sac. The assistant operator holds the compression for 60 more seconds after the thrombin injection is completed and then slowly releases the compression, while simultaneously the first operator monitors if there is any residual flow in the PSA sac on real-time US Doppler. The whole procedure is presented in Fig. 3. If there is present flow in the PSA sac, we perform the whole procedure again. Ten minutes after the thrombin injection, we perform color Doppler ultrasound examination of the blood flow through femoral, popliteal, and tibial posterior arteries. If there were no clinical and ultrasound signs of the peripheral artery insufficiency, no change in pulse oximetry recordings, pulmonary embolism, or systemic allergic reactions, patients were transferred to ward. Control color Doppler exam was scheduled 24 h after the procedure. We considered USGC repair or UGTI successful, if there was no blood flow in the PSA sac, 10 min and 24 h after the procedure. In the case of complete thrombosis of the PSA without residual flow, patients were declared free of the PSA and next color Doppler exam was scheduled in 30 days.