EXPANDED INDICATIONS FOR THE TREATMENT OF POSTCATHETERIZATION FEMORALPSEUDOANEURYSMS WITH ULTRASOUND-GUIDED COMPRESSION

BACKGROUND: The purpose of this study was to define the factors that p redict successful ultrasound-guided compression repair (UGCR) of postc atheterization femoral pseudoaneurysms (PA) and to determine risks for recurrence, the most appropriate follow-up, and the optimal managemen t of compression failures and recurrences. METHODS: A retrospective ch art review was made. RESULTS: UGCR thrombosed 52 of 60 PA (87%). Predi ctors of compression failure were PA size of 8 cm and an associated ar teriovenous fistula (AVF). AVF was the only predictor of recurrence. A ll seven recurrences (13%) were discovered on the first follow-up scan . Four were thrombosed with additional UGCR. Late rescanning after a m ean of 264 days identified no recurrences. Four anticoagulated patient s failed initial UGCR but were thrombosed in another session when thei r anticoagulation was briefly reversed. CONCLUSIONS: UGCR should be th e initial management of PA because it is safe, effective, and durable. Temporary discontinuation of anticoagulation and multiple prolonged c ompression sessions may help treat recalcitrant cases. One follow-up s can is adequate for most patients. Recurrences should be initially tre ated with repeat UGCR. Am J Surg. 1998;176:131-136. (C) 1998 by Excerp ta Medica, Inc.