Percutaneous treatment of pseudoaneurysms and arteriovenous fistulas after invasive vascular procedures

Abstract

Development of femoral artery pseudoaneurysms and arteriovenous fistulas represents a continuing problem after vascular diagnostic and interventional procedures. For most patients, ultrasound-guided compression is an effective method of treating such complications. However, in patients requiring a continuous anticoagulant regimen, in those with large arteriovenous fistulas or in patients suffering from painful groin hematomas, compression repair is less successful. We therefore assessed the feasibility, efficacy, and long-term results of interventional percutaneous treatment of these complications. In a 40-month period, we treated 53 consecutive patients with 30 pseudoaneurysms, 21 arteriovenous fistulas, and 2 combined lesions. The intervention was successful in 47 patients: 32 lesions were treated by implantation of covered stents, 14 by embolization techniques, and 1 by a combined procedure, surgical repair being necessary only in 6 patients. After a clinical and ultrasonic follow-up of 301 +/- 280 days, we noticed four late stent occlusions, especially in patients with poor peripheral runoff. Lesions with a distinct connection channel to the vessel lumen should be treated by coil embolization. In lesions originating from the femoral bifurcation with a broad base, surgical repair is necessary. Stenting of the superficial femoral artery with poor runoff should be avoided. Our results suggests that percutaneous closure of false aneurysms and arteriovenous fistulas after invasive procedures with unsuccessful ultrasonic compression repair is an attractive alternative to surgical treatment.