Femoral Artery Pseudoaneurysm - Answer Case 1 6/14/2009

This series of images from an abd/pelvis CT demonstrates a hyperdense focus of contrast adjacent to the left common femoral artery with a small neck communicating the two. The patient had a recent cardiac catheterization. This represents a Left common femoral artery pseudoaneurysm.

1. < 5% of arterial access

2. Risks - large catheter, anticoagulation, calcified arteries, HTN, too low a puncture, obesity

3. Physical Exam - pulsatile hematoma at puncture site with a bruit.

4. Ultrasound - rapid diagnosis

5. Small - spontaneously resolve

6. Complication - infection and rupture

7. Tx - surgery, ultrasound guided compression and ultrasound guided thrombin injection

8. US-compression - neck - compress 20-30 min - complications are embolization and thrombosis

9. US-thrombin - thrombin 1000 Units/mL - use 1mL syringe - slow injection into pseudoaneurysm away from the neck; occasionally require more than 1 injection; complication - distal thrombosis from thrombin in system.

Reference - VIR requisites (Kaufman et al)