Related Experiment Videos
Iatrogenic Femoral Artery Pseudoaneurysm
Bryan T. Piedad1, Itzhak Kronzon
1Noninvasive Cardiology Laboratory, New York University School of Medicine, 560 First Avenue, New York, NY 10016, USA. itzhak.kronzon@med.nyu.edu
Abstract:
A small (< 6 cm(3) in volume or 1.8 cm in diameter), uncomplicated iatrogenic femoral artery pseudoaneurysm in a reliable patient not requiring anticoagulation can be safely observed with weekly physical examinations and ultrasound evaluations until full thrombosis is documented. The patient should be informed that any symptoms or complications should be reported to a physician immediately. A pseudoaneurysm associated with limb ischemia, severe infection, neurologic deficit, skin necrosis, rapid expansion, or hemorrhage should be treated surgically. Also, surgery is recommended if less invasive treatment strategies have failed, or if a planned surgical procedure involving the groin is anticipated. Given its high success rate, low complication rate, and cost-effectiveness, ultrasound-guided thrombin injection should be considered as first-line treatment for uncomplicated iatrogenic femoral pseudoaneurysm. Ultrasound-guided compression repair is an effective alternative to thrombin injection, especially in institutions that have little or no experience with thrombin injection. Alternative treatment strategies, such as percutaneous endovascular stenting and perfusion ballooning, are generally not recommended as first-line treatment options, because they have not been studied as extensively as ultrasound-guided compression repair or thrombin injection. If no other options are available, however, these alternative approaches may be appropriate in certain clinical situations.
Insights
Small, uncomplicated femoral artery pseudoaneurysms can be safely monitored with physical exams and ultrasounds. Prompt medical attention is crucial for any concerning symptoms or complications.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Diagnostic Ultrasound
Background:
- Iatrogenic femoral artery pseudoaneurysms are a potential complication of arterial interventions.
- Management strategies range from observation to surgical intervention.
Purpose of the Study:
- To outline the management guidelines for iatrogenic femoral artery pseudoaneurysms.
- To evaluate the efficacy and safety of different treatment modalities.
Main Methods:
- Review of clinical presentation and diagnostic findings.
- Assessment of conservative management (observation with serial examinations).
- Evaluation of interventional treatments including ultrasound-guided thrombin injection and compression repair, and surgical options.
Main Results:
- Small, uncomplicated pseudoaneurysms can be safely observed with weekly physical examinations and ultrasound.
- Ultrasound-guided thrombin injection is a highly effective first-line treatment with a high success rate and low complication rate.
- Ultrasound-guided compression repair is a viable alternative, particularly where thrombin injection experience is limited.
- Surgical intervention is reserved for complicated cases, treatment failures, or anticipated groin procedures.
Conclusions:
- Conservative management is appropriate for select small, uncomplicated pseudoaneurysms.
- Ultrasound-guided thrombin injection is the preferred first-line treatment for uncomplicated iatrogenic femoral pseudoaneurysms.
- Surgical intervention remains essential for complicated pseudoaneurysms and treatment failures.