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. 2012 Jan;16(4):194-7.
doi: 10.5812/kowsar.22517464.3186. Epub 2012 Jan 15.

Femoral pseudoaneurysms requiring surgical treatment

Hannu Savolainen  1 , Iris Baumgartner  2 , Juerg Schmidli  2 , George Heller  2 , Do-Dai Do  2 , Torsten Willenberg  2
Affiliations

Femoral pseudoaneurysms requiring surgical treatment

Hannu Savolainen et al. Trauma Mon. 2012 Jan.

Abstract

Background: Despite use of arterial closure devices (APCDs) and thrombin injection , surgery is needed at times to repair femoral pseudoaneurysms (FPA) in patients undergoing endovascular interventions. We analysed the indications and results of surgical repair in a tertiary referral center performing more than 6.000 angiographies and/or interventions annually.

Objectives: The aim of this retrospective observational study was to identify local and clinical factors related to the need of surgical repair.

Patients and methods: In this retrospective study, 122 (0.06%) FPAs treated among 21060 patients over a period of five years were assessed. Patient characteristics and therapeutic procedures were analyzed through hospital records.

Results: There were 15.163 (72%) coronary and 5.897 (27%) peripheral interventions, respectively. In 89 (73%) patients, FPA was successfully treated by ultrasound guided compression (USGC) alone.Thirty-three (28%) patients underwent open surgical repair. Indication for operative treatment was hemodynamic instability in 9 (7%) patients, rapidly expanding haematoma unsuitable for USGC or after unsuccessful USGC in 23 (19%). One (0.8%) patient had an arterio-venous fistula. Intraoperative findings suggest that atypical endovascular access (e.g. deep femoral artery, lateral or medial puncture) and multiple puncture sites and/or laceration of the vessel wall were related to the need for surgery in 22 (67%) cases. Most patients had active antithrombotic therapy. Gender or the nature of procedure (diagnostic vs. intervention) did not increase risk for open repair. One (0.8%) patient died. No amputations were performed. Mean hospital stay of patients undergoing open surgical repair was 11 (range 4-36) days.

Conclusions: Technical puncture problems were identified in 2/3 of patients requiring open surgery.

Keywords: Angiography; Catheters; Endovascular; Femoral Artery; Indwelling.

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Figures

Figure 1.
Figure 1.. Scheme on intraoperative findings in 22 patients requiring surgical repair due to laceration at the puncture Site.
A) Lateral laceration of common femoral artery B) Laceration at profound femoral artery C) Medial or ventral laceration of common femoral artery D) Laceration of a side branch E) More than one laceration
See this image and copyright information in PMC

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