Duplex-guided compression of iatrogenic femoral artery pseudoaneurysms

The purpose of this report is to review our experience with duplex-guided compression in the management of iatrogenic femoral artery pseudoaneurysms. From February 1991 to July 1992, 13 consecutive asymptomatic femoral artery pseudoaneurysms were managed initially with duplex-guided compression. Twelve of these complications followed interventional cardiac procedures; the remaining case followed lysis of a femoral to tibial bypass. A Quantum Angiodynograph I duplex imager with a 5-MHz probe was used during this study. After the origin of the pseudoaneurysm was identified, compression was applied with the transducer head to obliterate flow in the pseudoaneurysm, while maintaining flow in the parent artery. Successful thrombosis was accomplished in 12 patients. The mean interval between the original femoral puncture and duplex-guided compression was 9.0 days (range, 1-22 days). The mean compression time was 30 minutes (range, 15-45 minutes). Pseudoaneurysm size ranged from 1.0 to 5.0 cm. Follow-up imaging, performed within 72 hours after compression, demonstrated sustained pseudoaneurysm thrombosis and patent femoral artery segments. Four patients were managed as out-patients, without the need for anesthesia or sedation. Eight patients were managed in the hospital, seven following interventional cardiac procedures, and one following bypass revision. Duplex-guided compression failed in one case. This patient was successfully treated operatively, at which time repair of both the profunda and superficial femoral artery was required. Asymptomatic iatrogenic femoral artery pseudoaneurysms can be successfully managed with duplex-guided compression. This maneuver appears to be a simple and cost-effective approach for initial management of these lesions.(ABSTRACT TRUNCATED AT 250 WORDS)