Management Of Femoral Artery Pseudoaneurysms Research Articles

Ultrasonography-guided endovascular management of femoral artery pseudoaneurysm after unintended dialysis catheterization with suture-mediated vascular closure devices.

Although iatrogenic pseudoaneurysm is an infrequent complication, it can be life threatening if ruptured. There are several treatment methods for managing this complication. This case report demonstrates a technique using ultrasonography-guided suture-mediated vascular closure devices without angiography to successfully treat iatrogenic superficial femoral pseudoaneurysm following an unintended hemodialysis catheter insertion. In particular, when it is difficult to use a contrast due to a patient's condition as in this case, suture-mediated vascular closure device with ultrasonography guidance can be used as a therapeutic method.

Outcomes of Femoral Artery Pseudoaneurysm in Intravenous Drug Abusers Managed at a Tertiary Care Center.

ObjectivesThe aim of this study was to assess the effects of ligation and excision of femoral artery pseudoaneurysm without revascularization in intravenous drug abusers presenting in the tertiary care center.MethodsThis was a retrospective study conducted at Shaheed Mohtarma Benazir Bhutto Institute, Karachi, Pakistan, and included 119 patients admitted for vascular injuries of the groin between June 2016 and June 2020. Data collected from the hospital's medical records included all intravenous drug addicts presented with mass near or at groin area only, while other pseudoaneurysm locations secondary to vascular trauma, arteriovenous fistula, and hemodialysis were excluded. SPSS Version 20.0 (IBM Corp., Armonk, NY, USA) was used for data analysis.ResultsThis study included 119 patients, all of whom presented and admitted to the Accident and Emergency Department, with a mean age of about 32 years ± 11.34 years and a mean duration of addiction of 2.47 years ± 1.37 years. Males constituted 83.2% of the patients, while females constituted 16.8%. The left femoral artery was affected more commonly than the right femoral artery, with an average of 75.6% and 24.4%, respectively. The most common presentation was bleeding from ruptured pseudoaneurysm (76.5%) and oozing with pulsatile mass (17.6%), while infected pulsatile swelling and misdiagnosis were uncommon. After surgical intervention, limb salvage was 95.8%, whereas mortality and amputation rate were 2.5 % and 1.7%, respectively.ConclusionThe optimal management of femoral artery pseudoaneurysm in intravenous drug addicts is ligation and excision of the pseudoaneurysm without revascularization.

Management of Femoral Artery Pseudoaneurysms in Patients Requiring Coronary Artery Bypass Grafting: Should the Same Treatment Paradigm Be Used as Those Not Undergoing CABG?

Management of Femoral Artery Pseudoaneurysms in Patients Requiring Coronary Artery Bypass Grafting: Should the Same Treatment Paradigm Be Used as Those Not Undergoing CABG?

Treatment of an extracapsular post‐renal biopsy pseudoaneurysm with ultrasound‐guided thrombin injection

Percutaneous renal biopsy is a convenient method to obtain allograft tissue for histologic evaluation. Vascular complications, such as arteriovenous (AV) fistula and pseudoaneurysm, following renal biopsy are well known, and they usually resolve without further intervention. When symptomatic, they should be treated. We present a patient on chronic anticoagulation who developed a pseudoaneurysm after percutaneous renal biopsy. Applying techniques learned in the management of femoral artery pseudoaneurysm, we treated our patient with ultrasound-guided thrombin injection.

Management of Femoral Artery Pseudo-Aneurysms in Iran: a Single Centre Report of 50 Cases

The aim of this study was to review the aetiology and surgical technique of treatment of all femoral artery pseudo-aneurysms that had presented to our centre during the previous 9 years and to compare the results of infected femoral artery pseudo-aneurysms and other kinds of pseudo-aneurysm.This retrospective case-note study consists of all femoral pseudo-aneurysms that have been managed in Sina hospital from 1996 to 2005.The intravenous injection of drugs (n = 26), arterial access for angiography (n = 17), trauma (n = 6) and vasculitis (n = 1) were the causes of pseudo-aneurysms. Surgical repair was indicated for all patients; however, routine surgical repair techniques were modified in some patients. Two deaths and one amputation occurred in intravenous drug abusers. The most frequent cause of femoral artery pseudo-aneurysm formation in our hospital is intravenous injection of drugs, which is associated with higher mortality and morbidity than other causes. In contrast to previous reports, our experience shows that triple vessel ligation (common, superficial and deep femoral arteries) can be a safe treatment for infected femoral artery pseudo-aneurysms. In addition, our results did not show the safety of common femoral artery ligation as a treatment of choice. However, it is recommended, due to the better results of elective extra-anatomic bypass than emergent extra-anatomic bypass. Repair of post-angiographic pseudo-aneurysms by interrupted sutures or patch angioplasty is associated with good results. Surgical repair of traumatic pseudo-aneurysms should be determined per case and can vary from local control to extra-anatomic bypass.

Ruptured femoral pseudoaneurysm presenting as a lateral abdominal wall hematoma

Lateral abdominal wall hematomas are rare. We describe a patient with a delayed rupture of a femoral artery pseudoaneurysm, who presented with such a hematoma. In contrast to other types of abdominal wall hematomas, which are often managed conservatively, a ruptured femoral artery pseudoaneurysm frequently requires emergent surgical intervention. Rupture of a pseudoaneurysm can be catastrophic. Due to the rising incidence of femoral artery pseudoaneuryms and shorter hospital stays, it is useful for the emergency physician to be familiar with the diagnosis and management of femoral artery pseudoaneurysms and their potentially life-threatening complications.

Ultrasound guided human thrombin injection. A new modality in the management of femoral artery pseudo-aneurysms.

We report our initial results of a prospective study of duplex ultrasound-guided injection (UGTI ) of thrombin in the management of femoral artery pseudo-aneurysms. We used human thrombin to avoid the increase in the human antibodies directed against fibrinogen, with the use of bovine thrombus, that preclude further utilisation of the bovine fibrin glue during cardio-thoracic surgery. From 1999 to 2001, 19 patients, aged 69 (range 52-85) years presented with 21 femoral pseudo-aneurysms were treated. The mean pseudoaneurysm diameter was 30 (15-55) mm. All but two were secondary to cardiac procedures and the common femoral artery was the injured vessel in all instances. Patients were referred within 2-21 days following their iatrogenic injury. Immediate thrombosis of the sac occurred in 19 (90%) of the 21 pseudo-aneurysms. After a second injection, complete occlusion occurred in the remaining two patients. Two patients (CI 95%; 1-19) with three femoral pseudo-aneurysms developed leg pain. Duplex ultrasound follow-up showed two recurrences (9.5% - CI 95%; 1-19) and both were treated by repeat UGTI. There was no conversion to surgical repair. This percutaneous minimally invasive technique is safe and effective in the management of iatrogenic pseudo-aneurysms in this high-risk group of patients. Human thrombin has significant advantages over bovine thrombin.

Iatrogenic femoral artery pseudoaneurysm: Studies relating to the current treatment strategies including observation, ultrasound-guided compression, and duplex-directed thrombin injection

These articles demonstrate 3 “conservative” management strategies for postcatheterization femoral artery pseudoaneurysms. The continuum of watchful waiting in selected patients to ultrasound-guided compression, to ultrasound-guided thrombin injection mirrors many of the changes in the surgical treatment of myriad disease states. Operative repair of these lesions, such as open cholecystectomy, is not going to be of historical importance because many of these lesions will still require open repair. However, with the ever-increasing use of catheter-based therapies, minimally invasive techniques that demonstrate similar efficacy and safety are needed. The most frequent complication of femoral artery catheterization is the development of a femoral artery pseudoaneurysm. Approximately 500,000 interventional cardiologic procedures are performed in the United States every year. This does not take into account the interventional radiologic and other (femoral arterial line placement) procedures used to gain access to the central arterial system via the femoral artery. The reported incidence of complications after femoral artery catheterization ranges from 0.2%–9%. Pseudoaneurysm formation has been reported as a complication in 0.05%–5% of all femoral artery catheterizations. Obviously, with the large number of procedures being performed each year, femoral artery pseudoaneurysm formation is not an uncommon lesion referred to general and vascular surgeons. The first article reviewed explores the conservative management of femoral artery pseudoaneurysms. This article is important in that it documents the benign natural history of a large number of these lesions. Although the conservatively managed patients were a relatively select group, they were not so select that the findings of the study become uninterpretable. This study demonstrates that many of these lesions can in fact be observed with frequent spontaneous resolution. The second article discusses another “conservative” management strategy for the treatment of femoral artery pseudoaneurysms, involving ultrasound-guided compression of the lesion. Ultrasound-guided compression has been adopted in many centers and has shown very good results. Success rates of 70%–100% have been reported. Unfortunately, a recurrence rate of 20% is still seen, especially in patients undergoing anticoagulant therapy. Also, a large number of patients fail this therapeutic method secondary to intolerance of the pain associated with compression. Still, it is clear that ultrasound-guided compression is a highly effective choice in many patients. The third article addresses duplex-directed thrombin injection, a novel technique that is being employed in certain centers. This technique appears to be quite effective and safe. Although this study included only 11 patients, this paper is one of a series of papers that have documented the efficacy and safety of the technique. Duplex-directed thrombin injection is also very expeditious with thrombosis, occurring in only 30 seconds in most patients. Surgical repair of femoral artery pseudoaneurysms will always be necessary for a number of these lesions. However, many can be observed with spontaneous thrombosis. Other techniques have been and are being designed to treat this common condition. With the economic pressure for decreased in-patient treatment, the conservative strategies that have been reviewed will continue to occupy a central role in the management of these lesions.

Spontaneous thrombosis of iatrogenic femoral artery pseudoaneurysms: Documentation with color Doppler and two-dimensional ultrasonography

Two-dimensional ultrasonography and color Doppler were used over an 18-month period for the diagnosis and management of femoral artery pseudoaneurysms in six patients with pulsatile groin masses found after catheterization. A diagnosis of pseudoaneurysm was made when color Doppler demonstrated pulsatile systolic flow into echolucent masses. One patient underwent surgical repair of a symptomatic pseudoaneurysm after the initial Doppler study. Serial color Doppler studies were performed in five subjects, all of whom showed resolution of flow after a mean of 18 days (range 7 to 42). Despite an absence of flow, one patient underwent surgical drainage of persistent hematoma. After a mean interval of 233 days (range 84 to 552) all patients have remained free of other complications or symptoms related to the pseudoaneurysm. This experience suggests that urgent surgical repair is not required in all cases of small iatrogenic pseudoaneurysms, and that asymptomatic patients can be safely followed with serial color Doppler examinations.