Abstract
PurposeTo evaluate factors associated with pseudoaneurysm (PSA) development.MethodsBetween January 2016 and May 2020, 30,196 patients had invasive vascular radiological or cardiac endovascular procedures that required arterial puncture. All patients with PSA were identified. A matched (age, gender, and type of the procedure) control group of 134 patients was created to reveal predictors of PSA formation.ResultsSingle PSAs were found in 134 patients. Fifty-three PSAs developed after radiological procedures (53/6555 [0.8%]), 31 after coronary artery procedures (31/18038 [0.2%]), 25 after non-coronary artery cardiac procedures (25/5603 [0.4%]), and 25 due to procedures in which the arterial puncture was unintended. Thirty-four PSAs (25.4%) were localized to the upper extremity arteries (vascular closure device [VCD], N = 0), while 100 (74.6%) arose from the lower extremity arteries (VCD, N = 37). The PSA prevalence was 0.05% (10/20478) in the radial artery, 0.1% (2/1818) in the ulnar artery, 1.2% (22/1897) in the brachial artery, and 0.4% (99/22202) in the femoral artery. Treatments for upper and lower limb PSAs were as follows: bandage replacement (32.4% and 14%, respectively), ultrasound-guided compression (11.8% and 1%, respectively), ultrasound-guided thrombin injection (38.2% and 78%, respectively), and open surgery (17.6% and 12%, respectively). Reintervention was necessary in 19 patients (14.2%). The prevalence of PSA for the punctured artery with and without VCD use was 37/3555 (1%) and 97/27204 (0.4%), respectively (OR, 2.94; 95% CI, 1.95–4.34; P<0.001). The effect of red blood cell (RBC) count (P<0.001), hematocrit value (P<0.001), hemoglobin value (P<0.001), international normalized ratio (INR; P<0.001), RBC count—INR interaction (P = 0.003), and RBC count—VCD use interaction (P = 0.036) on PSA formation was significant.ConclusionPatients in whom the puncture site is closed with a VCD require increased observation. Preprocedural laboratory findings are useful for the identification of patients at high risk of PSA formation.
Highlights
Invasive endovascular procedures are becoming increasingly popular worldwide
Fifty-three PSAs developed after radiological procedures (53/6555 [0.8%]), 31 after coronary artery procedures (31/18038 [0.2%]), 25 after non-coronary artery cardiac procedures (25/5603 [0.4%]), and 25 due to procedures in which the arterial puncture was unintended
Patients in whom the puncture site is closed with a vascular closure device (VCD) require increased observation
Summary
Invasive endovascular procedures are becoming increasingly popular worldwide. They can be associated with systemic (e.g., contrast-induced reactions such as allergy or nephropathy), as well as treatment-related local complications [1,2,3]. Pseudoaneurysm (PSA) development is the second most common complication in those undergoing procedures that require an arterial puncture [4]. PSAs can spontaneously thrombose, untreated cases may lead to rupture or get infected; most patients undergo some kind of treatment, such as the replacement of the pressure bandage, ultrasound-guided compression (UGC), ultrasoundguided thrombin injection (UGTI), and/or open surgical repair [4,5,6,7, 11,12,13,14,15]
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