Incidence, diagnosis and treatment of femoral pseudoaneurysm

Abstract

Background: The aim of the study was to assess the risk of iatrogenic damage to the femoral artery after cardiac catheterisation and to analyse the efficacy of therapeutic procedures applied in the treatment of femoral pseudoaneurysm.
Methods: 4916 cases of coronary angiography and 3263 cases of PTCA performed using femoral artery access were analysed. Ultrasound examination confirmed the presence of pseudoaneurysm in 60 patients. In all cases mechanical compression was applied at the site of arterial puncture, resulting in successful obliteration of the pseudoaneurysm in 19 cases. The remaining 25 patients were referred by a vascular surgeon to either surgical procedure or thrombin injection directly into the cavity of the pseudoaneurysm.
Results: Femoral artery pseudoaneurysm complicated 0.6% of coronary angiographies and 0.9% of angioplasty procedures. No correlation was observed between the frequency of this complication and sex, age or the intensity of the antiplatelet and antithrombotic treatment. The high degree of efficacy of the non-invasive approach resulted in little need for surgical intervention, which was applicable only in the case of one patient.
Conclusions: The compression of a pseudoaneurysm with an elastic band combined with ultrasound-guided compression is efficient in 60% of cases. Thrombin injection into the lumen of the pseudoaneurysm is a safe procedure and appears to be the most effective method of treatment.