Femoral pseudoaneurysms and current cardiac catheterization: Evaluation of risk factors and treatment

Abstract

Objectives We sought to determine the incidence of femoral pseudoaneurysm (FPA) following cardiac catheterization, identify the risk factors for FPA and factors influencing therapeutic strategy. Methods 11,992 consecutive patients who underwent cardiac catheterization via femoral artery were studied over a period of four years in one University Hospital. Our prospective case control group analysis registered patients who developed FPA after the procedure. Patient-related factors, procedure related factors and peri-procedure treatment were compared between the two groups. Results 76 FPA were diagnosed over the study period accounting for a global incidence of 0.6% procedures. By univariate analysis, interventional procedure ( p < 0.01), rhythmologic procedure ( p = 0.03), sheath ≥ 6F ( p = 0.04) and left groin puncture ( p < 0.001) were FPA risk factors. By multivariate analysis, interventional procedure (adjusted odds ratio [OR] = 1.99; 95% confidence interval [CI]1.14–3.44 p = 0.01) and left groin puncture (OR = 4.65; 95% CI, 1.78–12.1 p = 0.001) are independent predictive factors of FPA. FPA thrombosis was obtained by ultrasound guided compression (UGC) in 71% of the cases. By univariate analysis, PFA diameter larger than 4 cm ( p < 0.001), the use of anticoagulation ( p < 0.01) or GPIIbIIIa inhibitors ( p = 0.001) and UGC under anticoagulation ( p = 0.01) are predictive factors of need for FPA surgical repair. By multivariate analysis, FPA diameter > 4 cm and use of GPIIbIIIa inhibitors are independent predictive factors of FPA's surgical treatment. Superficial femoral puncture was predictive of successful UGC both by uni and multivariate analysis. Conclusions Our study shows that FPA occurrence is mainly due to by procedure-related factors. FPA size, level of puncture and the use of GPIIbIIIa inhibitors are independent predictive factors of need for surgical therapy.