Diagnosis and treatment of iatrogenic femoral artery pseudoaneurysm: a review

Abstract

A pseudoaneurysm is a pulsatile hematoma that communicates with an artery through a disruption in the arterial wall. Femoral pseudoaneurysm is a common complication of invasive procedures. It occurs in 0.1% to 0.2% of diagnostic angiograms and 3.5% to 5.5% of interventional procedures. Longer procedures, large-bore catheters, anticoagulation, and a faulty lower site of puncture are associated with a higher incidence of femoral pseudoaneurysm. Pseudoaneurysms are associated with the characteristic findings of a pulsatile mass, a palpable thrill, and an audible to-and-fro murmur. The diagnosis is confirmed by imaging of the pseudoaneurysm. A femoral arterial duplex study is the diagnostic imaging modality of choice. It can show the pseudoaneurysm, the degree of clotting, the communication with the femoral artery, and the blood flow velocity pattern within the artery, the communication, and the pseudoaneurysm. Small (less than 2 cm) femoral pseudoaneurysms clot spontaneously and usually require no treatment. Larger femoral pseudoaneurysms may lead to complications including rupture and compression of the adjacent femoral vein (with resulting venous thrombosis) or of the femoral nerve. Treatment may be surgical. However, recently it has been shown that direct, noninvasive compression of the pseudoaneurysm stops the blood flow in the communication and leads to pseudoaneurysm clotting and obliteration.