Abstract
Background:Despite use of arterial closure devices (APCDs) and thrombin injection , surgery is needed at times to repair femoral pseudoaneurysms (FPA) in patients undergoing endovascular interventions. We analysed the indications and results of surgical repair in a tertiary referral center performing more than 6.000 angiographies and/or interventions annually.Objectives:The aim of this retrospective observational study was to identify local and clinical factors related to the need of surgical repair.Patients and Methods:In this retrospective study, 122 (0.06%) FPAs treated among 21060 patients over a period of five years were assessed. Patient characteristics and therapeutic procedures were analyzed through hospital records.Results:There were 15.163 (72%) coronary and 5.897 (27%) peripheral interventions, respectively. In 89 (73%) patients, FPA was successfully treated by ultrasound guided compression (USGC) alone.Thirty-three (28%) patients underwent open surgical repair. Indication for operative treatment was hemodynamic instability in 9 (7%) patients, rapidly expanding haematoma unsuitable for USGC or after unsuccessful USGC in 23 (19%). One (0.8%) patient had an arterio-venous fistula. Intraoperative findings suggest that atypical endovascular access (e.g. deep femoral artery, lateral or medial puncture) and multiple puncture sites and/or laceration of the vessel wall were related to the need for surgery in 22 (67%) cases. Most patients had active antithrombotic therapy. Gender or the nature of procedure (diagnostic vs. intervention) did not increase risk for open repair. One (0.8%) patient died. No amputations were performed. Mean hospital stay of patients undergoing open surgical repair was 11 (range 4-36) days.Conclusions:Technical puncture problems were identified in 2/3 of patients requiring open surgery.
Highlights
Despite use of arterial closure devices (APCDs) and thrombin injection, surgery is needed at times to repair femoral pseudoaneurysms (FPA) in patients undergoing endovascular interventions
Intraoperative findings suggest that atypical endovascular access and multiple puncture sites and/or laceration of the vessel wall were related to the need for surgery in 22 (67%) cases
In a meta-analysis of 30 randomized trials with more than 5000 patients, concern was raised on the safety of the APCDs, which may have a higher incidence of haematoma and pseudoaneurysm than manual compression [4]
Summary
Despite use of arterial closure devices (APCDs) and thrombin injection , surgery is needed at times to repair femoral pseudoaneurysms (FPA) in patients undergoing endovascular interventions. We analysed the indications and results of surgical repair in a tertiary referral center performing more than 6.000 angiographies and/or interventions annually. In 89 (73%) patients, FPA was successfully treated by ultrasound guided compression (USGC) alone.Thirty-three (28%) patients underwent open surgical repair. Gender or the nature of procedure (diagnostic vs intervention) did not increase risk for open repair. In a meta-analysis of 30 randomized trials with more than 5000 patients, concern was raised on the safety of the APCDs, which may have a higher incidence of haematoma and pseudoaneurysm than manual compression [4]. A small number of patients will still need open surgical repair [9]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
