Femoral Pseudoaneurysms Requiring Surgical Treatment

Background: Despite use of arterial closure devices (APCDs) and thrombin injection , surgery is needed at times to repair femoral pseudoaneurysms (FPA) in patients undergoing endovascular interventions. We analysed the indications and results of surgical repair in a tertiary referral center performing more than ۶.۰۰۰ angiographies and/or interventions annually. Objectives: The aim of this retrospective observational study was to identify local and clinical factors related to the need of surgical repair. Patients and Methods: In this retrospective study, ۱۲۲ (۰.۰۶%) FPAs treated among ۲۱۰۶۰ patients over a period of five years were assessed. Patient characteristics and therapeutic procedures were analyzed through hospital records. Results: There were ۱۵.۱۶۳ (۷۲%) coronary and ۵.۸۹۷ (۲۷%) peripheral interventions, respectively. In ۸۹ (۷۳%) patients, FPA was successfully treated by ultrasound guided compression (USGC) alone.Thirty-three (۲۸%) patients underwent open surgical repair. Indication for operative treatment was hemodynamic instability in ۹ (۷%) patients, rapidly expanding haematoma unsuitable for USGC or after unsuccessful USGC in ۲۳ (۱۹%). One (۰.۸%) patient had an arterio-venous fistula. Intraoperative findings suggest that atypical endovascular access (e.g. deep femoral artery, lateral or medial puncture) and multiple puncture sites and/or laceration of the vessel wall were related to the need for surgery in ۲۲ (۶۷%) cases. Most patients had active antithrombotic therapy. Gender or the nature of procedure (diagnostic vs. intervention) did not increase risk for open repair. One (۰.۸%) patient died. No amputations were performed. Mean hospital stay of patients undergoing open surgical repair was ۱۱ (range ۴-۳۶) days. Conclusions: Technical puncture problems were identified in ۲/۳ of patients requiring open surgery.