Management plan of post-angiography false aneurysms of the groin

Background: False aneurysm (FA) of the groin is a potentially serious compl ication of angiographic procedures. We developed a management plan at St. G eorge's Hospital, and prospectively applied it to 14 consecutive cases over a period of one year. Patients and Methods: This report is a prospective cohort study of post-ang iography false aneurysms. Fourteen patients with groin FA presented to the vascular team between October 1995 and September 1996 (0.2% of 6926 angiogr aphic procedures). Nine of the 14 patients were fully anticoagulated at the time of treatment. Ultrasound-guided compression (USGC) was tried in 11 pa tients and was considered inappropriate in three. Embolization was attempte d in four patients and surgery was needed in seven patients. Results: The initial angiographic procedure was therapeutic in nine and dia gnostic in five patients. The median maximal dimension of the FA was 3 cm ( range 2-5). USGC was successful in three patients and failed in eight, seve n of them fully anticoagulated at the time of compression. Embolization of the FA was tried in four patients; all were anticoagulated, and embolizatio n was successful. Surgery was required in seven patients, one with infected groin and bleeding, another with FA at the site of a groin graft anastomos is, three with concomitant evacuation of large groin hematomas, one who ref used further angiographic procedures, and one who needed prolonged full ant icoagulation before the availability of the embolization. The operation was successful in all the patients except one, who died of myocardial infarcti on 24 hours after successful surgical closure of a FA. Conclusion: FA can be managed in a step-wise manner, starting with the noni nvasive USGC, embolization and surgery. Surgery is indicated if evacuation of a large hematoma is required, or the presence of infection is suspected. Emergency surgery is indicated for bleeding or imminent rupture.