Femoral Artery Pseudoaneurysms: Risk Factors, Prevalence, and Treatment Options

doi:10.1007/s10016-003-0056-4

Annals of Vascular Surgery

Volume 17, Issue 5, September 2003, Pages 503-508

https://doi.org/10.1007/s10016-003-0056-4 Get rights and content

Femoral artery pseudoaneurysms (PSA or false aneurysm) develop in about 1% of patients undergoing procedures that require femoral artery cannulation. PSA prolong hospitalization, consuming health-care resources, and result in significant morbidity. We designed a study to review the prevalence, risk factors, and treatment of PSA. We performed a retrospective, case-controlled study of patients diagnosed with PSA at a large, urban, tertiary-care teaching hospital. We reviewed 48 patients with PSA for our study. The estimated prevalence of PSA was 0.28%, with identical rates found for procedures done in the interventional radiology department and in the cardiac catheterization suite. Logistic regression identified three independent risk factors for developing PSA: being female (odds ratio 2.62), having an intervention performed (odds ratio 3.22), and not having a closure device used (odds ratio 10.2). Patients with PSA had longer hospital length of stay than that of patients without PSA. We found no statistically significant difference in failure or complication rates for the four treatment options and that spontaneous resolution of PSA does not correlate with its size. Thrombin injection and observation are effective, low-complication treatment options.

Section snippets

INTRODUCTION

Femoral artery pseudoaneurysms (PSA or false aneurysm) arise as a complication of procedures requiring femoral arterial access such as cardiac catheterization or peripheral angiography. Over the past decade, radiologists, cardiologists, and vascular surgeons have explored nonoperative treatments for PSA including duplex-directed manual occlusion (DDMO) and thrombin injection. Many recent studies suggest that thrombin injection may be the most effective treatment with the fewest complications.1,

Data Collection

After we obtained Institutional Review Board approval, we conducted a retrospective, case-controlled study of patients with iatrogenic PSA following femoral artery catheterization. We used the patient database of the noninvasive vascular laboratory at a large, urban, tertiary-care, teaching hospital to identify all patients diagnosed with PSA from August 2000 to April 2002 and reviewed their medical records. We excluded patients who had PSA of other etiologies—for example, PSA from a leaking

RESULTS

We identified 48 patients diagnosed with PSA following a femoral artery catheterization. There were 15,769 procedures done through the femoral artery in the cardiac catheterization suite and 1419 in the interventional radiology suite during the period studied. We calculated the prevalence of PSA as 0.28%, with a rate of 0.28% from procedures done in the cardiac suite and 0.28% from procedures done in the interventional radiology suite.

We present the results of the univariate analysis comparing

DISCUSSION

The prevalence of PSA calculated in this study is comparable to that found at other institutions.1, 2, 3, 4, 5, 6 The actual prevalence is probably higher than what we have calculated for a few reasons. First, we excluded patients diagnosed by other modalities such as CT and angiography. Second, some patients probably had small, asymptomatic PSA that were never suspected. Finally, some patients may have had delayed development or detection of PSA after discharge, and might have been treated at

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Citation Excerpt :
Most of the available options are derived from the larger experience existing on the management of femoral artery pseudoaneurysm (FAP). Management of the latter condition has almost completely shifted from surgical to nonsurgical treatment, which includes compression bandage, ultrasound-guided manual compression, or ultrasound-guided direct injection of thrombin.4–6 In contrast, surgery is still the most commonly reported treatment for RAP in both adults3,7,9 and children.10–12
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It is imperative that patients have adequate discharge instructions and knowing who to contact for questions regarding treatment or possible complications (Appendix A). In conclusion, UGTI is a safe and acceptable means of treatment for IFPA.1–3,7,16–27 Its use as an injection for pseudo-aneurysms has been widely accepted and deemed safe and effective for this purpose.26 Correctly performed, UGTI has a low morbidity rate and a success rate of 94%.30
Femoral pseudo-aneurysm (FPA) is a pulsatile hematoma (false aneurysm) of the femoral artery that communicates with an artery through a disruption in the arterial wall. Most often, FPA develops after an injury or angiographic access to the femoral artery with bleeding into the adjacent tissue. FPA is an uncommon complication, but a very significant one, that can have serious consequences. FPA can initially present as a new thrill or bruit, a pulsatile hematoma, or marked pain and tenderness near the site of arterial puncture. Doppler flow imaging has been the mainstay of diagnosis. Ultrasound (US)-guided compression was the treatment of choice. However, it carries drawbacks including length of time to compress for adequate closure of the artery, discomfort to patients, high recurrence rate in patients receiving anticoagulation, femoral artery thrombosis, and a success rate of only 75% overall.1, 2 An alternative to compression is US-guided thrombin injection (UGTI) of the FPA. This is a safe procedure that can be done as an outpatient or in an office setting. This paper will provide nursing guidelines and rationale as well as a nursing protocol for the management of patients who undergo UGTI for FPA.
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: Presented at the Southeastern Surgical Congress, Savannah, GA, February 9, 2003.

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Femoral Artery Pseudoaneurysms: Risk Factors, Prevalence, and Treatment Options

Section snippets

INTRODUCTION

Data Collection

RESULTS

DISCUSSION

Ann Vasc Surg

Eur J Vasc Endovasc Surg

J Vasc Surg

J Vasc Surg

Am J Surg

Ann Vasc Surg

J Vasc Surg

Sonographically guided thrombin injection of iatrogenic femoral pseudoaneurysms: further experience of a single institution

AJR Am J Roentgenol

A review of alternative approaches in the management of iatrogenic femoral pseudoaneurysms

Ann R Coll Surg Engl