ULTRASOUND-GUIDED COMPRESSION OF FEMORAL PSEUDOANEURYSM - AN AUDIT OFPRACTICE

Objective. To audit the practice of ultrasound-guided compression of f emoral pseudoaneurysm in a specialist cardiac hospital. Background. Fe moral pseudoaneurysm is an important complication of invasive cardiac procedures. This may require surgical repair but more recently ultraso und-guided compression for ablating pseudoaneurysms has been described . We investigated the success of such a procedure. Methods and Results . In a 26-month period, 56 patients were referred for ultrasound scann ing to exclude the formation of a femoral pseudoaneurysm following tra nsfemoral cardiac procedures. During this period, 5756 diagnostic card iac catherisations and 1165 coronary angioplasties were performed in o ur hospital (total of 6921 procedures). Of the 56 patients, 20 patient s (0.3% of 6921) were found to have a pseudoaneurysm. Ultrasound-guide d compression was attempted in 11 patients and was successful in 7 pat ients (64%). Of the patients who had failed ultrasound-guided compress ion, 2 proceeded to surgical closure and 2 were treated conservatively with compression stockings to facilitate thrombosis of the pseudoaneu rysm. Of those who did not have an attempted ultrasound-guided compres sion of the pseudoaneurysm (n=9), a conservative approach consisting o f resting the leg was adopted to facilitate spontaneous thrombosis of the pseudoaneurysm; repeat ultrasound scanning was needed for follow-u p and 1 patient required surgical closure in this group. Conclusions. In patients with a femoral pseudoaneurysm following an invasive cardia c procedure, ultrasound-guided compression may be useful as an immedia te step to ablate the pseudoaneurysm This avoids either prolonged leg rest and repeated ultrasound scanning or surgical intervention. Howeve r, ultrasound-guided compression is not always successful; in these pa tients, a period of conservative management with repeat ultrasound sca nning is appropriate to allow for the possible spontaneous thrombosis of the pseudoaneurysm. Surgical closure is needed in those patients wh ose pseudoaneurysm is enlarging, painful or remain patent. (C) 1998 El sevier Science Ireland Ltd.