Alternative percutaneous management of iatrogenic femoral artery pseudoaneurysms using plug-based closure devices after failed us-guided compression and evaluation of risk factors for compression failure

Abstract

Purpose:

Pseudoaneurysms (PAs) arise from the disruption of the arterial wall, resulting in extravasation of blood into the surrounding tissue. Iatrogenic sources are a leading cause of PA formation. There is an upward trend in the incidence of PAs due to the growing number of endovascular procedures. This study identifies the risk factors associated with the failure of Ultrasound-guided compression repair (UGCR) and evaluates the efficacy of vascular closure devices (VCDs) in the percutaneous treatment of iatrogenic femoral artery PAs. There are case reports in the literature, with a few cases reporting the use of VCDs for PA treatment. The aim is to contribute to the literature with a larger patient group.

Materials and methods:

Out of 107 patients with femoral PAs, 21 patients were treated with VCDs. All patients underwent preprocedural color Doppler ultrasonography to assess PA characteristics such as origin, diameter, extension, and neck size. The risk factors associated with the failure of UGCR were statistically analyzed. The VCD treatment involved using a 21G micropuncture needle, microwire, and appropriate vascular sheath (5–8 F) if necessary, followed by deploying a plug based VCD to induce thrombosis. Postprocedural ultrasonography control was performed for all patients to confirm the thrombosis and to see plug at the neck. All patients were summoned 1 week and 3 months later to undergo follow-up Doppler ultrasonography.

Results:

Postprocedural ultrasonography confirmed successful treatment. The results demonstrated that VCDs were effective in the treatment of almost all cases (except one failure), suggesting this technique as a viable, minimally invasive option for managing iatrogenic femoral artery PAs in interventional radiology.

Conclusion:

This method can be successfully used for iatrogenic femoral PAs with a neck smaller than 5 mm. It is an alternative method when other techniques fail.