ULTRASOUND-GUIDED NONSURGICAL CLOSURE OF POSTANGIOGRAPHIC FEMORAL-ARTERY INJURIES

Postcatheterization injuries at the vascular access site include pseud oaneurysms and arteriovenous fistulas. Traditional treatment of this c omplication has been surgical repair. This study describes a recently developed method for closing femoral pseudoaneurysms and arteriovenous fistulas by using external compression guided by Doppler color flow i maging. Thirty-six femoral artery injuries (31 pseudoaneurysms, 5 arte riovenous fistulas) were detected by color flow imaging in 35 patients with enlarging groin hematomas and/or groin bruits. All patients unde rwent a full trial of compression therapy, with an extended compressio n time limit of 240 minutes and a tag-team approach of two operators t o overcome manual fatiguing. The mechanical compression was titrated t o obliterate the vascular tracts to the aneurysms or of the arterioven ous fistulas and to maintain an adequate flow in the femoral artery, a s far as possible. All postangiographic pseudoaneurysms were successfu lly treated with a compression time ranging from 10 to 110 minutes, ev en in patients receiving prolonged anticoagulant therapy. Follow-up ul trasound examination the following morning and 4 to 5 days later confi rmed a continued closure in all patients, without side effects such as venous thrombosis or ischemia. In arteriovenous fistulas, compression therapy was successful in two cases without complications or recurren ces during follow-up. This study demonstrates that Doppler color flow ultrasound-guided compression of postangiographic femoral artery injur ies is a safe and technically simple device and may be implemented as a cost-effective, first-line treatment, with a high rate of success in pseudoaneurysms.