Skip to main content
NCBI home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1999 Jul;81(4):226–234.

A review of alternative approaches in the management of iatrogenic femoral pseudoaneurysms.

G J O'Sullivan 1, S A Ray 1, J S Lewis 1, A J Lopez 1, B W Powell 1, A H Moss 1, J A Dormandy 1, A M Belli 1, T M Buckenham 1
PMCID: PMC2503254  PMID: 10615187

Abstract

The management of iatrogenic pseudoaneurysms (IPAs) demands close co-operation between radiologist, vascular surgeon and plastic surgeon. Ideally, each patient should be reviewed employing a team approach. Many IPAs require only observation; those with a volume greater than 6 cm3 will require treatment as spontaneous thrombosis is uncommon. Radiological treatment options include ultrasound guided compression repair (UGCR), embolisation, and covered stenting. Occasionally, these are unsuccessful or contra-indicated, and the vascular surgical approach is discussed in detail. Finally, the role of the plastic surgeon in dealing with skin ischaemia is detailed.

Full text

PDF
226

Images in this article

227Figure 1
on p.227
228Figure 2
on p.228
228Figure 3
on p.228
229Figure 4
on p.229
229Figure 5
on p.229
230Figure 6
on p.230
230Figure 7
on p.230

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abrokwah J., Shenoy K. N., Armour R. H. False aneurysm of the thyrocervical trunk: an unconventional surgical approach. Eur J Vasc Endovasc Surg. 1996 Apr;11(3):373–374. doi: 10.1016/s1078-5884(96)80090-6. [DOI] [PubMed] [Google Scholar]
  2. Abu-Yousef M. M., Wiese J. A., Shamma A. R. The "to-and-fro" sign: duplex Doppler evidence of femoral artery pseudoaneurysm. AJR Am J Roentgenol. 1988 Mar;150(3):632–634. doi: 10.2214/ajr.150.3.632. [DOI] [PubMed] [Google Scholar]
  3. Akpinar B., De Geest R., DeGrieck I., Wellens F., Vanermen H. A surgical technique for post catheterisation femoral artery pseudoaneurysms. Eur J Vasc Surg. 1994 Sep;8(5):632–633. doi: 10.1016/s0950-821x(05)80604-8. [DOI] [PubMed] [Google Scholar]
  4. Altin R. S., Flicker S., Naidech H. J. Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: association with low femoral punctures. AJR Am J Roentgenol. 1989 Mar;152(3):629–631. doi: 10.2214/ajr.152.3.629. [DOI] [PubMed] [Google Scholar]
  5. Baker K. S., Tisnado J., Cho S. R., Beachley M. C. Splanchnic artery aneurysms and pseudoaneurysms: transcatheter embolization. Radiology. 1987 Apr;163(1):135–139. doi: 10.1148/radiology.163.1.3823426. [DOI] [PubMed] [Google Scholar]
  6. Beebe H. G. Endovascular surgery: issues and opportunities as we approach the new millennium. J Endovasc Surg. 1998 Feb;5(1):1–5. doi: 10.1583/1074-6218(1998)005<0001:ESIAOA>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  7. Birchall D., Fields J. M., Chalmers N., Walker M. G. Case report: delayed superficial femoral artery pseudoaneurysm rupture following successful compression therapy. Clin Radiol. 1997 Aug;52(8):629–630. doi: 10.1016/s0009-9260(97)80258-9. [DOI] [PubMed] [Google Scholar]
  8. Blais C., Bonneau D. Postangioplasty pseudoaneurysm treated with a vascular stent. AJR Am J Roentgenol. 1994 Jan;162(1):238–239. doi: 10.2214/ajr.162.1.8273682. [DOI] [PubMed] [Google Scholar]
  9. Bostwick J., 3rd, Hill H. L., Nahai F. Repairs in the lower abdomen, groin, or perineum with myocutaneous or omental flaps. Plast Reconstr Surg. 1979 Feb;63(2):186–194. doi: 10.1097/00006534-197902000-00006. [DOI] [PubMed] [Google Scholar]
  10. Coley B. D., Roberts A. C., Fellmeth B. D., Valji K., Bookstein J. J., Hye R. J. Postangiographic femoral artery pseudoaneurysms: further experience with US-guided compression repair. Radiology. 1995 Feb;194(2):307–311. doi: 10.1148/radiology.194.2.7824703. [DOI] [PubMed] [Google Scholar]
  11. Cope C., Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection. AJR Am J Roentgenol. 1986 Aug;147(2):383–387. doi: 10.2214/ajr.147.2.383. [DOI] [PubMed] [Google Scholar]
  12. Cragg A. H., Dake M. D. Percutaneous femoropopliteal graft placement. Radiology. 1993 Jun;187(3):643–648. doi: 10.1148/radiology.187.3.8497609. [DOI] [PubMed] [Google Scholar]
  13. DiPrete D. A., Cronan J. J. Compression ultrasonography. Treatment for acute femoral artery pseudoaneurysms in selected cases. J Ultrasound Med. 1992 Sep;11(9):489–492. doi: 10.7863/jum.1992.11.9.489. [DOI] [PubMed] [Google Scholar]
  14. Eggeling T., Osterhues H. H., Pöhler E., Kochs M., Hombach V. Einfluss des Druckverbandes auf angiologische Komplikationen nach diagnostischer Koronarangiographie. Z Kardiol. 1994 Sep;83(9):623–625. [PubMed] [Google Scholar]
  15. Eichlisberger R., Frauchiger B., Schmitt H., Jäger K. Aneurysma spurium nach arterieller Katheterisierung: Diagnose und Verlaufskontrolle. Ultraschall Med. 1992 Apr;13(2):54–58. doi: 10.1055/s-2007-1005276. [DOI] [PubMed] [Google Scholar]
  16. Feld R., Patton G. M., Carabasi R. A., Alexander A., Merton D., Needleman L. Treatment of iatrogenic femoral artery injuries with ultrasound-guided compression. J Vasc Surg. 1992 Dec;16(6):832–840. doi: 10.1067/mva.1992.41519. [DOI] [PubMed] [Google Scholar]
  17. Fellmeth B. D., Buckner N. K., Ferreira J. A., Rooker K. T., Parsons P. M., Brown P. R. Postcatheterization femoral artery injuries: repair with color flow US guidance and C-clamp assistance. Radiology. 1992 Feb;182(2):570–572. doi: 10.1148/radiology.182.2.1732983. [DOI] [PubMed] [Google Scholar]
  18. Fellmeth B. D., Roberts A. C., Bookstein J. J., Freischlag J. A., Forsythe J. R., Buckner N. K., Hye R. J. Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression. Radiology. 1991 Mar;178(3):671–675. doi: 10.1148/radiology.178.3.1994400. [DOI] [PubMed] [Google Scholar]
  19. Fromm S. H., Lucas C. E. Obturator bypass for mycotic aneurysm in the drug addict. Arch Surg. 1970 Jan;100(1):82–83. doi: 10.1001/archsurg.1970.01340190084019. [DOI] [PubMed] [Google Scholar]
  20. Habscheid W., Landwehr P. Das Aneurysma spurium der Arteria femoralis nach Herzkatheteruntersuchung: eine prospektive Sonographiestudie. Z Kardiol. 1989 Sep;78(9):573–577. [PubMed] [Google Scholar]
  21. Hessel S. J., Adams D. F., Abrams H. L. Complications of angiography. Radiology. 1981 Feb;138(2):273–281. doi: 10.1148/radiology.138.2.7455105. [DOI] [PubMed] [Google Scholar]
  22. Katzenschlager R., Ugurluoglu A., Ahmadi A., Hülsmann M., Koppensteiner R., Larch E., Maca T., Minar E., Stümpflen A., Ehringer H. Incidence of pseudoaneurysm after diagnostic and therapeutic angiography. Radiology. 1995 May;195(2):463–466. doi: 10.1148/radiology.195.2.7724767. [DOI] [PubMed] [Google Scholar]
  23. Kent K. C., McArdle C. R., Kennedy B., Baim D. S., Anninos E., Skillman J. J. A prospective study of the clinical outcome of femoral pseudoaneurysms and arteriovenous fistulas induced by arterial puncture. J Vasc Surg. 1993 Jan;17(1):125–133. doi: 10.1067/mva.1993.41707. [DOI] [PubMed] [Google Scholar]
  24. Kotval P. S., Khoury A., Shah P. M., Babu S. C. Doppler sonographic demonstration of the progressive spontaneous thrombosis of pseudoaneurysms. J Ultrasound Med. 1990 Apr;9(4):185–190. doi: 10.7863/jum.1990.9.4.185. [DOI] [PubMed] [Google Scholar]
  25. Kresowik T. F., Khoury M. D., Miller B. V., Winniford M. D., Shamma A. R., Sharp W. J., Blecha M. B., Corson J. D. A prospective study of the incidence and natural history of femoral vascular complications after percutaneous transluminal coronary angioplasty. J Vasc Surg. 1991 Feb;13(2):328–335. [PubMed] [Google Scholar]
  26. Lammert G. K., Merine D., White R. I., Jr, Fishman E. K., Porterfield J. K. Embolotherapy of a high-flow false aneurysm by using an occlusion balloon, thrombin, steel coils, and a detachable balloon. AJR Am J Roentgenol. 1989 Feb;152(2):382–384. doi: 10.2214/ajr.152.2.382. [DOI] [PubMed] [Google Scholar]
  27. Lemaire J. M., Dondelinger R. F. Percutaneous coil embolization of iatrogenic femoral arteriovenous fistula or pseudo-aneurysm. Eur J Radiol. 1994 May;18(2):96–100. doi: 10.1016/0720-048x(94)90272-0. [DOI] [PubMed] [Google Scholar]
  28. Levy P. J., Holt J. B., Close T. P., Rush D. S., Haynes J. L. Rare presentation of anastomotic iliac artery false aneurysm: rupture with formation of ilio-iliac arteriovenous fistula. Am Surg. 1993 Nov;59(11):713–715. [PubMed] [Google Scholar]
  29. Logan S. E., Mathes S. J. The use of a rectus abdominis myocutaneous flap to reconstruct a groin defect. Br J Plast Surg. 1984 Jul;37(3):351–353. doi: 10.1016/0007-1226(84)90077-8. [DOI] [PubMed] [Google Scholar]
  30. Marin M. L., Veith F. J., Cynamon J., Panetta T. F., Bakal C. W., Kerr A., Parodi J. C. Transfemoral endoluminal repair of a penetrating vascular injury. J Vasc Interv Radiol. 1994 Jul-Aug;5(4):592–594. doi: 10.1016/s1051-0443(94)71559-1. [DOI] [PubMed] [Google Scholar]
  31. Marin M. L., Veith F. J., Lyon R. T., Cynamon J., Sanchez L. A. Transfemoral endovascular repair of iliac artery aneurysms. Am J Surg. 1995 Aug;170(2):179–182. doi: 10.1016/s0002-9610(99)80281-5. [DOI] [PubMed] [Google Scholar]
  32. Marin M. L., Veith F. J., Panetta T. F., Cynamon J., Bakal C. W., Suggs W. D., Wengerter K. R., Baronè H. D., Schonholz C., Parodi J. C. Transfemoral endoluminal stented graft repair of a popliteal artery aneurysm. J Vasc Surg. 1994 Apr;19(4):754–757. doi: 10.1016/s0741-5214(94)70052-4. [DOI] [PubMed] [Google Scholar]
  33. Marin M. L., Veith F. J., Panetta T. F., Cynamon J., Sanchez L. A., Schwartz M. L., Lyon R. T., Bakal C. W., Suggs W. D. Transluminally placed endovascular stented graft repair for arterial trauma. J Vasc Surg. 1994 Sep;20(3):466–473. doi: 10.1016/0741-5214(94)90147-3. [DOI] [PubMed] [Google Scholar]
  34. May J., White G., Waugh R., Yu W., Harris J. Transluminal placement of a prosthetic graft-stent device for treatment of subclavian artery aneurysm. J Vasc Surg. 1993 Dec;18(6):1056–1059. [PubMed] [Google Scholar]
  35. McGlinchey I., Baxter G. M. Technical report: an alternative mechanical technique of pseudoaneurysm compression therapy. Clin Radiol. 1997 Aug;52(8):621–624. doi: 10.1016/s0009-9260(97)80256-5. [DOI] [PubMed] [Google Scholar]
  36. Mitchell D. G., Needleman L., Bezzi M., Goldberg B. B., Kurtz A. B., Pennell R. G., Rifkin M. D., Vilaro M., Baltarowich O. H. Femoral artery pseudoaneurysm: diagnosis with conventional duplex and color Doppler US. Radiology. 1987 Dec;165(3):687–690. doi: 10.1148/radiology.165.3.3317501. [DOI] [PubMed] [Google Scholar]
  37. Moresco K., Bonn J., DiMuzio P., Consigny P. M. 1998 SCVIR Gary J. Becker Young Investigator Award. Endovascular repair of arterial pseudoaneurysms with use of a perfusion balloon catheter. J Vasc Interv Radiol. 1998 Mar-Apr;9(2):187–198. doi: 10.1016/s1051-0443(98)70258-1. [DOI] [PubMed] [Google Scholar]
  38. Nahai F., Hill L., Hester T. R. Experiences with the tensor fascia lata flap. Plast Reconstr Surg. 1979 Jun;63(6):788–799. [PubMed] [Google Scholar]
  39. Oweida S. W., Roubin G. S., Smith R. B., 3rd, Salam A. A. Postcatheterization vascular complications associated with percutaneous transluminal coronary angioplasty. J Vasc Surg. 1990 Sep;12(3):310–315. [PubMed] [Google Scholar]
  40. Parodi J. C. Endovascular repair of abdominal aortic aneurysms and other arterial lesions. J Vasc Surg. 1995 Apr;21(4):549–557. doi: 10.1016/s0741-5214(95)70186-9. [DOI] [PubMed] [Google Scholar]
  41. Parodi J. C., Palmaz J. C., Barone H. D. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991 Nov;5(6):491–499. doi: 10.1007/BF02015271. [DOI] [PubMed] [Google Scholar]
  42. Paulson E. K., Hertzberg B. S., Paine S. S., Carroll B. A. Femoral artery pseudoaneurysms: value of color Doppler sonography in predicting which ones will thrombose without treatment. AJR Am J Roentgenol. 1992 Nov;159(5):1077–1081. doi: 10.2214/ajr.159.5.1414779. [DOI] [PubMed] [Google Scholar]
  43. Paulson E. K., Kliewer M. A., Hertzberg B. S., O'Malley C. M., Washington R., Carroll B. A. Color Doppler sonography of groin complications following femoral artery catheterization. AJR Am J Roentgenol. 1995 Aug;165(2):439–444. doi: 10.2214/ajr.165.2.7618573. [DOI] [PubMed] [Google Scholar]
  44. Ramakantan R., Shah P. Steel coil embolization of a post-traumatic pseudoaneurysm of the superficial femoral artery. Injury. 1990 Nov;21(6):410–411. doi: 10.1016/0020-1383(90)90135-h. [DOI] [PubMed] [Google Scholar]
  45. Ramasastry S. S., Liang M. D., Hurwitz D. J. Surgical management of difficult wounds of the groin. Surg Gynecol Obstet. 1989 Nov;169(5):418–422. [PubMed] [Google Scholar]
  46. Rankin R. N., McKenzie F. N., Ahmad D. Embolization of arteriovenous fistulas and aneurysms with detachable balloons. Can J Surg. 1983 Jul;26(4):317–320. [PubMed] [Google Scholar]
  47. Rankin R. N., Youngson G. G., McKenzie F. N. Management of superior gluteal artery aneurysm by percutaneous balloon catheter occlusion: a case report. Surgery. 1979 Feb;85(2):235–237. [PubMed] [Google Scholar]
  48. Rapoport S., Sniderman K. W., Morse S. S., Proto M. H., Ross G. R. Pseudoaneurysm: a complication of faulty technique in femoral arterial puncture. Radiology. 1985 Feb;154(2):529–530. doi: 10.1148/radiology.154.2.3966139. [DOI] [PubMed] [Google Scholar]
  49. Rivers S. P., Lee E. S., Lyon R. T., Monrad S., Hoffman T., Veith F. J. Successful conservative management of iatrogenic femoral arterial trauma. Ann Vasc Surg. 1992 Jan;6(1):45–49. doi: 10.1007/BF02000667. [DOI] [PubMed] [Google Scholar]
  50. Roberts S. R., Main D., Pinkerton J. Surgical therapy of femoral artery pseudoaneurysm after angiography. Am J Surg. 1987 Dec;154(6):676–680. doi: 10.1016/0002-9610(87)90242-x. [DOI] [PubMed] [Google Scholar]
  51. Saito S., Arai H., Kim K., Aoki N., Tsurugida M. Percutaneous transfemoral spring coil embolization of a pseudoaneurysm of the femoral artery. Cathet Cardiovasc Diagn. 1992 Jul;26(3):229–231. doi: 10.1002/ccd.1810260313. [DOI] [PubMed] [Google Scholar]
  52. Sharma R. P., Shetty P. C., Burke T. H., Shepard A. D., Khaja F. Treatment of false aneurysm by using a detachable balloon. AJR Am J Roentgenol. 1987 Dec;149(6):1279–1280. doi: 10.2214/ajr.149.6.1279. [DOI] [PubMed] [Google Scholar]
  53. Sheikh K. H., Adams D. B., McCann R., Lyerly H. K., Sabiston D. C., Kisslo J. Utility of Doppler color flow imaging for identification of femoral arterial complications of cardiac catheterization. Am Heart J. 1989 Mar;117(3):623–628. doi: 10.1016/0002-8703(89)90737-0. [DOI] [PubMed] [Google Scholar]
  54. Skillman J. J., Kim D., Baim D. S. Vascular complications of percutaneous femoral cardiac interventions. Incidence and operative repair. Arch Surg. 1988 Oct;123(10):1207–1212. doi: 10.1001/archsurg.1988.01400340033006. [DOI] [PubMed] [Google Scholar]
  55. Soots G., Mikati A., Warembourg H., Jr, Watel A., Noblet D. Treatment of lymphorrhea with exposed or infected vascular prosthetic grafts in the groin using sartorius myoplasty. J Cardiovasc Surg (Torino) 1988 Jan-Feb;29(1):42–45. [PubMed] [Google Scholar]
  56. Steinsapir E. S., Coley B. D., Fellmeth B. D., Roberts A. C., Hye R. J. Selective management of iatrogenic femoral artery injuries. J Surg Res. 1993 Jul;55(1):109–113. doi: 10.1006/jsre.1993.1116. [DOI] [PubMed] [Google Scholar]
  57. Trubel W., Staudacher M., Magometschnigg H., Wolner E. Das Aneurysma spurium nach iatrogener arterieller Punktion--Inzidenz, Risikofaktoren und chirurgische Therapie. Wien Klin Wochenschr. 1993;105(5):139–143. [PubMed] [Google Scholar]
  58. Uflacker R., Mourão G. S., Piske R. L. Treating complications of subclavian vein puncture by embolization of the internal mammary artery. Cardiovasc Intervent Radiol. 1991 Mar-Apr;14(2):115–117. doi: 10.1007/BF02577708. [DOI] [PubMed] [Google Scholar]
  59. Waterhouse N., Healy C. Vastus lateralis myocutaneous flap for reconstruction of defects around the groin and pelvis. Br J Surg. 1990 Nov;77(11):1275–1277. doi: 10.1002/bjs.1800771125. [DOI] [PubMed] [Google Scholar]
  60. Wyman R. M., Safian R. D., Portway V., Skillman J. J., McKay R. G., Baim D. S. Current complications of diagnostic and therapeutic cardiac catheterization. J Am Coll Cardiol. 1988 Dec;12(6):1400–1406. doi: 10.1016/s0735-1097(88)80002-0. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES