Beyond the Common Femoral Artery: The Overlooked Risk of External Pudendal Artery Injury

Femoral arterial access is a cornerstone of numerous interventional procedures including percutaneous coronary intervention (PCI), structural valve and neurovascular interventions. Although common femoral artery (CFA) injuries are well-recognised, branch-vessel injuries, such as the external pudendal artery, remain underreported, despite the potential for significant bleeding and haemodynamic compromise. We present a 91-year-old lady who developed a rapidly expanding groin haematoma following PCI via femoral access, despite optimal technique using a micropuncture access kit under ultrasound guidance. She developed haemodynamic collapse, necessitating multiple blood transfusions. CT angiography revealed active extravasation from the external pudendal artery, which was successfully managed with coil embolisation. The patient stabilised postprocedure and was eventually discharged home. As PCI expands to older and higher risk cohorts, this case underscores the need for heightened awareness of branch vessel anatomy, advocating for a multimodal approach integrating fluoroscopic wire tracking with ultrasound guidance to mitigate branch vessel injury.