LEA 39. Surgical Management of Complex Femoral Artery Pseudoaneurysms in the Era of a Minimally Invasive Intervention

Abstract

The objective of this study was to identify the etiology, clinical presentation, and surgical morbidity and mortality of femoral artery pseudoaneurysms (FAPs) requiring surgery at our institute. We also proposed a classification of FAPs and an algorithm for systematic stepwise surgical decision-making of FAPs based on intraoperative findings. Patients with FAPs requiring surgical intervention at our institution between January 2016 and April 2019 were included. Data in this study were collected prospectively. A total of 54 (male, 42; female, 12) patients with FAPs who underwent surgical intervention at our institute were included in the study. The mean age of the population was 50.1 years. Most of the FAPs were iatrogenic (83.3%), whereas 13% were seen in intravenous drug abusers and 3.7% were traumatic. In iatrogenic FAPs, percutaneous coronary intervention was the most common cause (33.3%), followed by dialysis access (31.5%) and surgery (13%). Common femoral artery was the most commonly involved artery (51.9%) in FAPs in our study. Right-side pseudoaneurysms were more common than left-side pseudoaneurysms (72.2% vs 27.8%). Pseudoaneurysm clot culture was positive in 63%. Staphylococcus aureus (29.6%) was the most common organism isolated. There was a significant correlation between the cause of the pseudoaneurysm and surgery done, even though our surgical decision was based on intraoperative findings. Post-dialysis pseudoaneurysms underwent primary rent closure (P = .014); post-percutaneous coronary intervention pseudoaneurysms underwent patch repair (P = .04); and postsurgical pseudoaneurysms (P = .001) and intravenous drug abuse pseudoaneurysms (P = .041) underwent bipolar ligation. There was a significant difference (P = .04) in the age of patients who required amputation after bipolar ligation compared with those who did not (55 years vs 41 years). Mortality in our study was 3.7%; morbidity was mostly wound related, seen in 24% of patients. Re-exploration was needed in 11.1% of patients. Even in the era of increasing minimally invasive approaches for various surgical problems, including FAPs, there is still a role for open surgical pseudoaneurysm repair if indicated, and it can be done with acceptable morbidity and mortality.