Radiology, Vol 178, 671-675, Copyright © 1991 by Radiological Society of North America

ARTICLES

Postangiographic femoral artery injuries: nonsurgical repair with US- guided compression

BD Fellmeth, AC Roberts, JJ Bookstein, JA Freischlag, JR Forsythe, NK Buckner and RJ Hye
Department of Diagnostic Radiology, University of California, San Diego Medical Center 92103.

Ultrasound-guided compression repair (UGCR) of catheterization-related femoral artery injuries was evaluated as a possible new imaging-guided interventional procedure. Thirty-nine femoral artery injuries (35 pseudoaneurysms, four arteriovenous fistulas) were detected with color Doppler flow imaging in patients with enlarging groin hematomas and/or groin bruits 6 hours to 14 days after catheterization procedures. UGCR was not performed in 10 patients due to spontaneous thrombosis (n = 4), infection (n = 1) or skin ischemia (n = 1), unsuitable anatomy (n = 3), or excessive discomfort (n = 1). The remaining 29 patients underwent a full trial of compression therapy, and the lesion was eliminated in 27. Follow-up color flow scans were obtained after 24-72 hours in all 27 successful cases and at 1-15 months in 19; no recurrences or complications occurred. UGCR for acute injuries is safe and technically simple and is promising as a cost-effective, first-line treatment for uncomplicated catheterization-related femoral artery injuries. UGCR is probably not appropriate for long-standing injuries.

This article has been cited by other articles:

				M.-A. Ohlow, M.-A. Secknus, H. von Korn, R. Weiss, and B. Lauer Percutaneous Thrombin Injection for Treatment of Iatrogenic Femoral Artery Pseudoaneurysms: A Case for Caution Angiology, July 1, 2008; 59(3): 372 - 375. [Abstract] [PDF]

				M. H. Eslami and B. A. Silvia Endovascular Repair of Femoral Artery Pseudoaneurysm After Orthopedic Surgery With Balloon-Expandable Covered Stents Vascular and Endovascular Surgery, May 1, 2008; 42(2): 176 - 179. [Abstract] [PDF]

				M. Luedde, U. Krumsdorf, J. Zehelein, B. Ivandic, T. Dengler, H. A. Katus, and C. Tiefenbacher Treatment of Iatrogenic Femoral Pseudoaneurysm by Ultrasound-Guided Compression Therapy and Thrombin Injection Angiology, September 1, 2007; 58(4): 435 - 439. [Abstract] [PDF]

				G. W. Webber, J. Jang, S. Gustavson, and J. W. Olin Contemporary Management of Postcatheterization Pseudoaneurysms Circulation, May 22, 2007; 115(20): 2666 - 2674. [Full Text] [PDF]

				A. T. Hirsch, Z. J. Haskal, N. R. Hertzer, C. W. Bakal, M. A. Creager, J. L. Halperin, L. F. Hiratzka, W. R.C. Murphy, J. W. Olin, J. B. Puschett, et al. ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary A Collaborative Report From the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation J. Am. Coll. Cardiol., March 21, 2006; 47(6): 1239 - 1312. [Full Text] [PDF]

				P. A. Stone, A. F. AbuRahma, S. K. Flaherty, and M. C. Bates Femoral Pseudoaneurysms Vascular and Endovascular Surgery, March 1, 2006; 40(2): 109 - 117. [Abstract] [PDF]

				A. K. Dasyam, W. D. Middleton, and S. A. Teefey Development of Nonobstructive Intraarterial Thrombi After Injection of Thrombin into Pseudoaneurysms Am. J. Roentgenol., February 1, 2006; 186(2): 401 - 405. [Abstract] [Full Text] [PDF]

				N. E. A. Saad, W. E. A. Saad, M. G. Davies, D. L. Waldman, P. J. Fultz, and D. J. Rubens Pseudoaneurysms and the Role of Minimally Invasive Techniques in Their Management RadioGraphics, October 1, 2005; 25(suppl_1): S173 - S189. [Abstract] [Full Text] [PDF]

				O. Demirbas, T. Batyraliev, Z. Eksi, and I. Pershukov Femoral Pseudoaneurysm Due to Diagnostic or Interventional Angiographic Procedures Angiology, September 1, 2005; 56(5): 553 - 556. [Abstract] [PDF]

				Swelling of volar aspect of the wrist Postgrad. Med. J., August 1, 2005; 81(958): e11 - e11. [Full Text] [PDF]

				H. E. Rodriguez, L. Leon, P. Schalch, N. Labropoulos, M. Borge, and P. G. Kalman Arteriovenous Access: Managing Common Problems Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2005; 17(2): 155 - 166. [Abstract] [PDF]

				V. Vazquez, M. Reus, A. Pinero, D. Abellan, M. Canteras, M. E. de Rueda, D. Morales, and P. Parrilla Human Thrombin for Treatment of Pseudoaneurysms: Comparison of Bovine and Human Thrombin Sonogram-Guided Injection Am. J. Roentgenol., May 1, 2005; 184(5): 1665 - 1671. [Abstract] [Full Text] [PDF]

				A M Dixon and D S Enion Pseudoaneurysm of the breast: case study and review of literature Br. J. Radiol., August 1, 2004; 77(920): 694 - 697. [Abstract] [Full Text] [PDF]

				M. Lenartova and T. Tak Iatrogenic Pseudoaneurysm of Femoral Artery: Case Report and Literature Review Clin. Med. Res., July 1, 2003; 1(3): 243 - 247. [Abstract] [Full Text] [PDF]

				K. Kruger, M. Zahringer, F.-D. Sohngen, A. Gossmann, O. Schulte, C. Feldmann, D. Strohe, and K. Lackner Femoral Pseudoaneurysms: Management with Percutaneous Thrombin Injections--Success Rates and Effects on Systemic Coagulation Radiology, February 1, 2003; 226(2): 452 - 458. [Abstract] [Full Text] [PDF]

				J. R. Edgerton, D. O. Moore, D. Nichols, B.W. Lane, M. J. Magee, T. M. Dewey, and M. J. Mack Obliteration of femoral artery pseudoaneurysm by thrombin injection Ann. Thorac. Surg., October 1, 2002; 74(4): S1413 - 1415. [Abstract] [Full Text] [PDF]

				M. Kelm, S. M. Perings, T. Jax, T. Lauer, F. C. Schoebel, M. P. Heintzen, C. Perings, and B. E. Strauer Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: Implications for risk stratification and treatment J. Am. Coll. Cardiol., July 17, 2002; 40(2): 291 - 297. [Abstract] [Full Text] [PDF]

				K. Hamraoui, S. M. P. G. Ernst, P. F. H. M. van Dessel, J. C. Kelder, J. M. ten Berg, M. J. Suttorp, W. Jaarsma, and T. H. W. Plokker Efficacy and safety of percutaneous treatment of iatrogenic femoral artery pseudoaneurysm by biodegradable collagen injection J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1297 - 1304. [Abstract] [Full Text] [PDF]

				E. R Mohler III, M. E Mitchell, J. P Carpenter, D E. Strandness Jr, M. R Jaff, J. A Beckman, and M. Gerhard-Herman Therapeutic thrombin injection of pseudoaneurysms: a multicenter experience Vascular Medicine, November 1, 2001; 6(4): 241 - 244. [Abstract] [PDF]

				W. C. Calton Jr., D. P. Franklin, J. R. Elmore, and D. C. Han Ultrasound-Guided Thrombin Injection Is a Safe and Durable Treatment for Femoral Pseudoaneurysms Vascular and Endovascular Surgery, September 1, 2001; 35(5): 379 - 383. [Abstract] [PDF]

				S. B. Reeder, D. M. Widlus, and M. Lazinger Low-Dose Thrombin Injection to Treat Iatrogenic Femoral Artery Pseudoaneurysms Am. J. Roentgenol., September 1, 2001; 177(3): 595 - 598. [Abstract] [Full Text] [PDF]

				M B Matson, R A Morgan, and A-M Belli Percutaneous treatment of pseudoaneurysms using fibrin adhesive Br. J. Radiol., August 1, 2001; 74(884): 690 - 694. [Abstract] [Full Text] [PDF]

				E. K. Paulson, R. C. Nelson, C. E. Mayes, D. H. Sheafor, M. H. Sketch Jr., and M. A. Kliewer Sonographically Guided Thrombin Injection of latrogenic Femoral Pseudoaneurysms: Further Experience of a Single Institution Am. J. Roentgenol., August 1, 2001; 177(2): 309 - 316. [Abstract] [Full Text] [PDF]

				J D Ferguson, P J Whatling, V Martin, J Walton, and A P Banning Ultrasound guided percutaneous thrombin injection of iatrogenic femoral artery pseudoaneurysms after coronary angiography and intervention Heart, April 1, 2001; 85(4): 5e - 5. [Abstract] [Full Text]

				N. L. McNeil and T. W. I. Clark Sonographically Guided Percutaneous Thrombin Injection Versus Sonographically Guided Compression for Femoral Artery Pseudoaneurysms Am. J. Roentgenol., February 1, 2001; 176(2): 459 - 462. [Full Text] [PDF]

				L. La Perna, J. W. Olin, D. Goines, M. B. Childs, and K. Ouriel Ultrasound-Guided Thrombin Injection for the Treatment of Postcatheterization Pseudoaneurysms Circulation, November 7, 2000; 102(19): 2391 - 2395. [Abstract] [Full Text] [PDF]

				J. A. Pezzullo, D. E. Dupuy, and J. J. Cronan Percutaneous Injection of Thrombin for the Treatment of Pseudoaneurysms After Catheterization: An Alternative to Sonographically Guided Compression Am. J. Roentgenol., October 1, 2000; 175(4): 1035 - 1040. [Abstract] [Full Text] [PDF]

				M. Witz, M. Werner, J. Bernheim, A. Shnaker, J. Lehmann, and Z.'e. Korzets Ultrasound-guided compression repair of pseudoaneurysms complicating a forearm dialysis arteriovenous fistula Nephrol. Dial. Transplant., September 1, 2000; 15(9): 1453 - 1454. [Full Text] [PDF]

				E. K. Paulson, D. H. Sheafor, M. A. Kliewer, R. C. Nelson, L. B. Eisenberg, M. W. Sebastian, and M. H. Sketch Jr Treatment of Iatrogenic Femoral Arterial Pseudoaneurysms: Comparison of US-guided Thrombin Injection with Compression Repair Radiology, May 1, 2000; 215(2): 403 - 408. [Abstract] [Full Text]

				C. Thalhammer, A. S. Kirchherr, F. Uhlich, J. Waigand, and C. M. Gross Postcatheterization Pseudoaneurysms and Arteriovenous Fistulas: Repair with Percutaneous Implantation of Endovascular Covered Stents1 Radiology, January 1, 2000; 214(1): 127 - 131. [Abstract] [Full Text]

				D. P. Brophy, R. G. Sheiman, P. Amatulle, and C. M. Akbari Iatrogenic Femoral Pseudoaneurysms: Thrombin Injection after Failed US-guided Compression1 Radiology, January 1, 2000; 214(1): 278 - 282. [Abstract] [Full Text]

				D. E. Elliott, G. A. Thieme, and J. A. Drose Sonographic Diagnosis of a Brachial Artery Pseudoaneurysm Journal of Diagnostic Medical Sonography, September 1, 1999; 15(5): 193 - 196. [PDF]

				M. T. Massie, M. J. Rohrer, P. A. Cardullo, and B. S. Cutler Ultrasound-Guided Compression for Treatment of latrogenic Arteriovenous Fistulae Vascular and Endovascular Surgery, May 1, 1998; 32(3): 263 - 268. [Abstract] [PDF]

				T Chatterjee, D-D Do, F Mahler, and B Meier Pseudoaneurysm of femoral artery after catheterisation: treatment by a mechanical compression device guided by colour Doppler ultrasound Heart, May 1, 1998; 79(5): 502 - 504. [Abstract] [Full Text]

				D. Brandt, K. D. Robinson, R. T. Gregory, R. J. DeMasi, C. S. Dickson, R. G. Gayle, F. N. Parent, and K. A. Sorrell The Durability of Duplex-Directed Manual Occlusion of Femoral False Aneurysms Vascular and Endovascular Surgery, March 1, 1998; 32(2): 157 - 162. [Abstract] [PDF]

				R. Altstidl, H. B. Lehmkuhl, E. Voss, C. Herold, D. Becker, E. Giinter, and K. Bachmann Ultrasound-Guided Nonsurgical Closure of Postangiographic Femoral Artery Injuries Vascular and Endovascular Surgery, November 1, 1997; 31(6): 781 - 790. [Abstract] [PDF]

				D. A. Hodgett, S. S. Kang, and W. H. Baker Ultrasound-Guided Compression Repair of Catheter-Related Femoral Artery Pseudoaneurysms is Impaired by Anticoagulation Vascular and Endovascular Surgery, September 1, 1997; 31(5): 639 - 644. [Abstract] [PDF]

				M. Gwechenberger, R. Katzenschlager, G. Heinz, M. Gottsauner-Wolf, P. Probst, and M. Gwechenberger Use of a Collagen Plug Versus Manual Compression for Sealing Arterial Puncture Site After Cardiac Catheterization Angiology, February 1, 1997; 48(2): 121 - 126. [Abstract] [PDF]

				S. Green, D. Ramaswamy, and R. F. Neville Ultrasound-Guided Compression of a Brachial Artery Pseudoaneurysm: A Case Report Vascular and Endovascular Surgery, March 1, 1996; 30(2): 143 - 147. [Abstract] [PDF]

				M. E. Mclvor and M. D. Herbst Noninvasive Management of Pseudoaneurysms by the Novel Use of a Compression Device: Case Reports Vascular and Endovascular Surgery, January 1, 1995; 29(1): 59 - 63. [PDF]

				D. A. Merton Ultrasound Examination of Invasive Procedure Puncture Site Comnplications: A Review of Scan Techniques and Benefits of Color Doppler Imaging Journal of Diagnostic Medical Sonography, November 1, 1993; 9(6): 297 - 305. [Abstract] [PDF]