Coil Embolization of Iatrogenic Femoral Artery Pseudoaneurysm

Abstract

<h3>Introduction and Objective</h3> Femoral pseudoaneurysms are not uncommon after cardiac catheterizations. Multiple methods are used to treat pseudoaneurysms including ultrasound guided thrombin injection, direct pressure, stent grafting, open surgical repair and endovascular coil embolization. We describe a patient with severe comorbidities with complicated femoral pseudoaneurysm treated with emergent coil embolization via radial access. <h3>Case Report</h3> An obese 77-year-old female with multiple comorbidities, who was deemed a prohibitive risk for cardiac surgery, was taken to the cardiac cath lab for percutaneous coronary intervention. She underwent balloon valvuloplasty of the aortic valve in addition to placement of drug-eluting stents in the left main, LAD, diagonal and circumflex arteries. This was accomplished through a 10 French sheath placed in the left common femoral artery. The groin was closed with two Perclose devices. An immediate hematoma developed in the left groin. Manual pressure was held until the patient was stable. She was then transported to the ICU. Shortly after arrival in the ICU, the patient developed hypotension. She was taken back to the cardiac cath lab where she underwent an arteriogram via the left radial artery. Contrast extravasation was noted from the left femoral artery. Several attempts to control hemorrhage with balloon occlusion were unsuccessful. Urgent vascular surgery consultation was obtained. Patient was emergently moved to the endovascular operating room. Left femoral arteriography via left radial access revealed active contrast extravasation from the femoral bifurcation into a large pseudoaneurysm cavity. A vertebral catheter was used to advance a glide wire into the pseudoaneurysm. A microcatheter was then advanced into the pseudoaneurysm cavity. The pseudoaneurysm was embolized with two detachable 6 × 12 Penumbra Ruby coils. Post embolization, there was minimal flow into the pseudoaneurysm. Duplex ultrasound performed the next day revealed minimal flow in the pseudoaneurysm cavity with a maximal flow lumen of 1 cm. This was observed and it spontaneously thrombosed. The patient ultimately recovered and returned to her baseline medical status. <h3>Discussion</h3> A variety of methods are available for the treatment of pseudoaneurysms. Traditional treatment options include ultrasound-guided manual compression, thrombin injection and open surgery. With the development and evolution of endovascular techniques, less invasive options such as stent graft coverage and coil embolization can be successfully utilized. There are few case reports of coil embolization of femoral pseudoaneurysms. In selected patients, coil embolization may be an effective alternative to surgical treatment and can be offered by the vascular surgeon.