Immediate Ultrasound Confirmation With Rescue Compression for Femoral Hemostasis After Endovascular Therapy for Lower
Kazuki Haraguchi1, Hisashi Koga1, Tomohiro Kawasaki1
1Department of Cardiology, Shin Koga Hospital, Kurume, Japan.
Summary
This study repurposed ultrasound for immediate hemostasis confirmation after endovascular therapy (EVT), significantly lowering femoral artery pseudoaneurysm (FAP) rates. This active strategy ensures better outcomes and avoids unnecessary interventions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Femoral artery pseudoaneurysm (FAP) is a known complication of endovascular therapy (EVT).
- Routine ultrasound surveillance for FAP has been questioned due to potential surveillance bias.
- An active ultrasound strategy could improve hemostasis assessment post-EVT.
Purpose of the Study:
- To evaluate an active ultrasound-guided hemostasis protocol for femoral artery access post-EVT.
- To determine if immediate ultrasound confirmation and rescue compression reduces FAP incidence.
- To assess the management and outcomes of FAP in this protocol.
Main Methods:
- Retrospective analysis of 1002 patients undergoing femoral access EVT.
- Implementation of a hemostasis protocol including manual compression and immediate bedside Doppler ultrasound.
- Rescue compression guided by ultrasound for incomplete hemostasis, followed by mandatory next-morning ultrasound.
Main Results:
- Overall FAP incidence was 1.0% (10/1002), with 8 detected on morning ultrasound and 2 delayed events.
- 80% of detected pseudoaneurysms (8/10) were managed with compression alone.
- 3 cases required thrombin injection; no patients needed surgical repair.
Conclusions:
- Immediate ultrasound confirmation with rescue compression is associated with low FAP incidence post-EVT.
- This active protocol offers a practical advantage over passive surveillance, with most pseudoaneurysms managed non-surgically.
- The protocol is implementable with standard equipment and may reduce FAP rates in peripheral endovascular practice.
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