Femoral Pseudoaneurysms: To Treat Or Not To Treat, When To Treat, And How To Treat
Jonathan W. Nazha, BA, Huong Truong, MD, Randy Shafritz, MD, William Beckerman, MD.
Rutgers-Robert Wood Johnson Medical School, Piscataway Township, NJ, USA.
OBJECTIVES: To examine success rates of treatment for iatrogenic femoral pseudoaneurysm (PSA) and establish criteria for choosing amongst treatment options.
METHODS: We performed a retrospective review of 179 patients between November 2013-June 2019 with confirmed femoral pseudoaneurysm on arterial duplex, examining factors such as patient demographics, inciting procedure, time to PSA diagnosis, and PSA treatment. We also examined the anatomic characteristics of the PSA, including size and vessel involved (external iliac, common, superficial and deep femoral).
RESULTS: 1029 femoral duplex studies were performed, of which 17.5% (179) were positive for PSA. Among the positive studies, the treatment methods included observation (19%), thrombin injection (11.4%), US-guided compression (2.2%) and open surgery (16.8%). The average age was 69.7yo, with incidence of male (50.3%) matching that of females (49.7%). Many of these patients had hypertension (81%), CAD (63.7%), and were on antiplatelet therapy (53.6%). These PSA largely occurred at CFA (78.2%) and during low profile cardiac catheterization defined as <9Fr (82.1%). Overall intervention success rates of observation, US-guided compression, thrombin injection, and open surgery were 19%, 16.8%, 51.4%, and 100% respectively. The procedural conversion rates between observation to thrombin injection and open surgery were 11.8% and 2.9% respectively, US-guided compression to thrombin was 25% and thrombin injection to open surgery was 16.7%. Chi-square and t-tests were performed comparing success and failure for these treatment modalities, which showed that gender (p=0.038), ESRD (p=0.031), DM (p=0.023), index procedure (p=0.0006) and size of PSA (p=0.0264) had statistically significant effect on success or failure of the chosen treatment. Odds ratio (OR) was further performed. Consequently, males had a 0.27 OR of succeeding with thrombin injection as compared to their female counterpart, patients with ESRD or DM both had an OR of 0.11 of having resolution of PSA with observation alone compared to patients without ESRD or DM.
CONCLUSIONS: Pseudoaneurysms are a known complication of transfemoral arterial procedures. It has yet to be established which treatment course is most appropriate under which circumstances. This study is a step towards establishing a stronger set of criteria for discerning between treatment options, maximizing treatment success while minimizing risk to patients. Future investigation to establish an accurate interventional framework will require larger samples of varied treatment options to compare outcomes amongst the different forms of treatment.
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