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

Ayham Al-Shatanawi1,2, Uzma Aftab1, Patrick Tran1,3,4

  • 1Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK, nhs.uk.

Case Reports in Cardiology
|May 18, 2026
PubMed

Insights

A rare external pudendal artery injury after femoral access for percutaneous coronary intervention (PCI) caused severe bleeding. Prompt coil embolisation successfully treated the bleeding, highlighting the need for vigilance in complex cases.

Area of Science:

  • Interventional Cardiology
  • Vascular Surgery
  • Radiology

Background:

  • Femoral arterial access is crucial for procedures like percutaneous coronary intervention (PCI).
  • While common femoral artery (CFA) injuries are known, injuries to smaller branch vessels, such as the external pudendal artery, are underreported.
  • These injuries can lead to significant bleeding and hemodynamic instability.

Purpose of the Study:

  • To report a case of external pudendal artery injury following PCI.
  • To emphasize the importance of recognizing and managing branch vessel injuries during femoral access.
  • To advocate for improved techniques to prevent such complications.

Main Methods:

  • A case report of a 91-year-old female patient who underwent PCI.
  • Ultrasound-guided micropuncture technique was used for femoral access.
  • Computed tomography angiography (CTA) was used for diagnosis.
  • Successful management with coil embolisation of the injured external pudendal artery.

Main Results:

  • The patient developed a rapidly expanding groin hematoma and hemodynamic collapse post-PCI.
  • CTA revealed active extravasation from the external pudendal artery.
  • Coil embolisation effectively controlled the bleeding.
  • The patient stabilized and was discharged.

Conclusions:

  • Branch vessel injury, specifically to the external pudendal artery, is an underreported complication of femoral arterial access during PCI.
  • Heightened awareness of vascular anatomy and potential injury sites is essential, particularly in elderly and high-risk patients.
  • A multimodal imaging approach, combining ultrasound guidance with fluoroscopic wire tracking, may help mitigate the risk of branch vessel injury.

Keywords:
coil embolisationexternal pudendal arteryfemoral access complicationpercutaneous coronary intervention

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