Ultrasound-guided compression for the treatment of iatrogenic femoral pseudoaneurysms

To assess the emerging use of ultrasound-guided compression (USGC) to treat iatrogenic femoral artery pseudoaneurysm (PA), we reviewed the experience in the accredited vascular laboratory of a large community teaching hospital from June 1993 to August 1994. Femoral duplex ultrasonography was done on 94 consecutive patients suspected of having PA. Twenty-eight PAs were found in 27 patients (14 women and 13 men; mean age, 62 years). Causes included cardiac angiography (n = 9), coronary angioplasty (n = 4), coronary stent placement (n = 12), and peripheral angioplasty (n = 3). Aneurysms were identified 1 to 90 days (median, 6 days) after femoral procedures, and their size ranged from 0.9 cm to 8.0 cm (mean, 2.5 cm). Fifteen patients (53%) were receiving systemic anticoagulation, 7 (25%) had spontaneous resolution, 10 (36%) were treated by femoral stitch arteriorrhaphy, and 11 (39%) were treated by USGC. Compression included vascular surgery standby, identification of PA neck (channel to native artery), 10-minute compression intervals to obliterate flow with a 5 MHz duplex ultrasound probe, and restudy at 24 hours. This protocol resulted in successful thrombosis in 8 patients (73%) but failed in 3 patients (37%), who required operative repair. Large aneurysm size, PA neck size, and systemic anticoagulation did not influence successful compression of PAs. Advanced age of the PA and operator inexperience were factors believed to negatively influence success. These data suggest that USGC is safe and effective and causes less morbidity than traditional repair, and it has emerged as the initial treatment of choice for iatrogenic femoral pseudoaneurysms.