Selective Management of latrogenic Femoral Artery Injuries

Abstract

Increased femoral artery catheterization for therapy and diagnosis has resulted in a concomitant increase in iatrogenic femoral artery injuries. A 33-month experience at two affiliated institutions was reviewed to evaluate the results of a selective approach to management of these complications. During this period, 9576 femoral artery catheterizations were performed. Eightynine femoral artery injuries were treated surgically or by ultrasound-guided compression therapy. Cardiac catheterization procedures predominated and 61% of patients were anticoagulated. Thirty-eight cases were treated surgically: 14 pseudoaneurysms, 16 hematomas, 6 arteriovenous fistulas, 2 thromboses. Local anesthesia was used in 28 cases (74%). Arterial repair was required in 34 cases, with control being achieved below the inguinal ligament in 33 cases (97%). Punctures were found in the superficial femoral or profunda femoral rather than the common femoral artery in 17 of 38 cases (44%, P < 0.001 compared with the ultrasound group). There were two deaths (5.3%), six wound infections (16%), and no limb loss. Ultrasound-guided compression was preferentially used for stable or slowly expanding pseudoaneurysms. Cases with large hematomas causing skin ischemia were treated surgically. The pseudoaneurysms ranged from 2 to 7 cm in diameter. This technique was effective in 46 of 51 cases (90%). A single thromboembolic complication was treated by thrombolysis. There were no late recurrences. We conclude that (1) iatrogenic femoral artery injuries are associated with postcatheterization anticoagulation and punctures not located in the common femoral artery; (2) injuries requiring surgery can usually be treated under local anesthesia with infrainguinal arterial control; (3) ultrasound-guided compression is an effective method for treating iatrogenic pseudoaneurysms not associated with large hematomas.