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Selective management of iatrogenic femoral artery injuries
E S Steinsapir1, B D Coley, B D Fellmeth
1Department of Surgery, San Diego VA Medical Center, California.
Insights
Iatrogenic femoral artery injuries from catheterization are common, especially in anticoagulated patients. Ultrasound-guided compression effectively treats pseudoaneurysms, while surgery under local anesthesia manages other complications.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Femoral artery catheterization is increasingly used for diagnosis and therapy.
- This has led to a rise in iatrogenic femoral artery injuries.
- A selective management approach was evaluated over 33 months.
Purpose of the Study:
- To assess the outcomes of a selective management strategy for iatrogenic femoral artery injuries.
- To compare surgical and ultrasound-guided compression therapies.
- To identify risk factors associated with these injuries.
Main Methods:
- Review of 9576 femoral artery catheterizations and 89 treated injuries.
- Surgical management for 38 cases (pseudoaneurysms, hematomas, fistulas, thromboses).
- Ultrasound-guided compression for 51 cases, primarily pseudoaneurysms.
Main Results:
- Surgical repair under local anesthesia was successful in 97% of cases.
- Injuries were associated with anticoagulation and non-common femoral artery punctures.
- Ultrasound-guided compression achieved 90% effectiveness for pseudoaneurysms.
Conclusions:
- Iatrogenic femoral artery injuries are linked to anticoagulation and puncture location.
- Surgery for these injuries can often be performed under local anesthesia.
- Ultrasound-guided compression is a viable treatment for selected pseudoaneurysms.
Abstract:
Increased femoral artery catheterization for therapy and diagnosis has resulted in a concomitant increase in iatrogenic femoral artery injuries. A 33-month experience at two affiliated institutions was reviewed to evaluate the results of a selective approach to management of these complications. During this period, 9576 femoral artery catheterizations were performed. Eighty-nine femoral artery injuries were treated surgically or by ultrasound-guided compression therapy. Cardiac catheterization procedures predominated and 61% of patients were anticoagulated. Thirty-eight cases were treated surgically: 14 pseudoaneurysms, 16 hematomas, 6 arteriovenous fistulas, 2 thromboses. Local anesthesia was used in 28 cases (74%). Arterial repair was required in 34 cases, with control being achieved below the inguinal ligament in 33 cases (97%). Punctures were found in the superficial femoral or profunda femoral rather than the common femoral artery in 17 of 38 cases (44%, P < 0.001 compared with the ultrasound group). There were two deaths (5.3%), six wound infections (16%), and no limb loss. Ultrasound-guided compression was preferentially used for stable or slowly expanding pseudoaneurysms. Cases with large hematomas causing skin ischemia were treated surgically. The pseudoaneurysms ranged from 2 to 7 cm in diameter. This technique was effective in 46 of 51 cases (90%). A single thromboembolic complication was treated by thrombolysis. There were no late recurrences. We conclude that (1) iatrogenic femoral artery injuries are associated with postcatheterization anticoagulation and punctures not located in the common femoral artery; (2) injuries requiring surgery can usually be treated under local anesthesia with infrainguinal arterial control; (3) ultrasound-guided compression is an effective method for treating iatrogenic pseudoaneurysms not associated with large hematomas.