Da. Weatherford et al., ULTRASOUND-GUIDED COMPRESSION FOR THE TREATMENT OF IATROGENIC FEMORALPSEUDOANEURYSMS, Southern medical journal, 90(2), 1997, pp. 223-226
To assess the emerging use of ultrasound-guided compression (USGC) to
treat iatrogenic femoral artery pseudoaneurysm (PA.), we reviewed the
experience in the accredited vascular laboratory of a large community
teaching hospital from June 1993 to August 1994. Femoral duplex ultras
onography was done on 94 consecutive patients suspected of having PA.
Twenty-eight PAs were found in 27 patients (14 women and 13 men; mean
age, 62 years). Causes included cardiac angiography (n = 9), coronary
angioplasty (n = 4), coronary stent placement (n = 12), and peripheral
angioplasty (n = 3). Aneurysms were identified 1 to 90 days (median;
6 days) after femoral procedures, and their size ranged from 0.9 cm to
8.0 cm (mean, 2.5 cm). Fifteen patients (53%) were receiving systemic
anticoagulation, 7 (25%) had spontaneous resolution, 10 (36%) were tr
eated by femoral stitch arteriorrhaphy, and 11 (39%) were treated by U
SGC. Compression included vascular surgery standby, identification of
PA neck (channel to native artery), 10-minute compression intervals to
obliterate flow with a 5 MHz duplex ultrasound probe, and restudy at
24 hours. This protocol resulted in successful thrombosis in 8 patient
s (73%) but failed in 3 patients (37%), who required operative repair.
Large aneurysm size, PA neck size, and systemic anticoagulation did n
ot influence successful compression of PAs. Advanced age of the PA and
operator inexperience were factors believed to negatively influence s
uccess. These data suggest that USGC is safe and effective and causes
less morbidity than traditional repair, and it has emerged as the init
ial treatment of choice for iatrogenic femoral pseudoaneurysms.