The incidence of vascular complications is on the rise due to the higher number of radiological procedures now performed via the femoral artery. The incidence of femoral artery pseudoaneurysm is around 1% following angiographies and interventional procedures. The other arterial complications that occur are arterial thrombosis, hematoma formation and arterivenous fistula. The longer duration of complex interventional procedures, usage of wide bore catheters and sheaths, and extensive anticoagulant therapy during the procedure are some of the risk factors responsible for the rising incidence of these pseudoaneurysms.
By definition, a pseudoaneurysm is a pulsatile hematoma which communicates with an artery through a disruption in the arterial wall. Clinically a pseudoaneurysm presents as a pulsatile mass often with a bruit or palpable thrill and to-and-fro murmur. Ultrasound with Doppler plays a crucial role in the diagnosis of these iatrogenic vascular abnormalities. It demonstrates the cavity of the pseudoaneurysm, its size and communication with the femoral artery. A swirling pattern of blood flow may be seen in the pseudoaneurysm and the velocities can be measured in the pseudoaneurysm, its neck and the femoral artery. Documentation of the to-an-fro flow with spectral Doppler is essential to making the diagnosis. The size of the aneurysm may guide the physician as to whether a conservative approach or treatment is indicated. Kronzon, et al in his study reported that smaller aneurysms [< 2 cm] may usually be followed up; however depending on the size of the pseudoaneurysm a number of treatment options can be offered.
A study by Toursarkissian, et al concluded that over 80% of stable pseudoaneurysms [pseudoaneurysms less than 3 cm in diameter were considered stable] and AV fistulae underwent spontaneous closure. Patients who had severe symptoms with an enlarging hematoma, groin infection, ischemia or nerve compression at the time of presentation were treated aggressively.
When treatment is indicated, radiological measures are now replacing the conventional surgical vascular repairs. Most of these minimally-invasive treatment options are ultrasound guided, the most common being direct compression of the pseudoaneurysm and percutaneous thrombin injection into the lumen of the pseudoaneurysm, both under ultrasound guidance. Compression therapy may not be very successful if there is an associated arterivenous fistula. The introduction of these procedures has reduced the morbidity and hospital stay of the patient. Embolization and stent placements may also be performed in indicated cases.