Incidence and predictors of post-catheterization femoral artery pseudoaneurysms

Background: Femoral artery pseudoaneurysm (FAP) is a troublesome complication after transfemoral catheter procedures. The incidence and predictors of FAP as a separate entity have not been extensively studied. Aim: Detect prospectively the incidence and predictors of post catheterization FAP. Methods: From June 2009 till June 2011, we prospectively included all patients who underwent catheterization from the femoral approach. Duplex ultrasound was performed in cases with clinical suspicion of vascular complications. Clinical data and procedural variables were compared with a control group of 200 randomly selected patients. We performed univariate analysis and a logistic regression model for multivariate analysis. Results: The incidence of FAP was 3.42%. Eighty FAPs (66.7%) were related to a diagnostic catheterization while 40(33.3%) were related to an interventional procedure. The mean age of patients with FAP was 55.36 ± 10.68 yrs; 57.5% were females. At diagnosis 81.66% of the patients were on antiplatelet therapy, 35% were on heparin or warfarin and 16.66% were on both, with mean value of INR for patients on warfarin 2.2 ± 0.76. FAPs were connected to the common femoral artery in 29.1% of patients, to the SFA in 54.1% and to the profunda in 16.6%. Female gender, obesity and hypertension significantly enhanced the risk for FAP. Also diagnostic angiography, low puncture, multiple punctures and the use of dual antiplatelet and/or anticoagulant therapy were independent procedure-related risk factors for FAP. Conclusion: Femoral artery pseudoaneurysms are not uncommon. Female gender, obesity, hypertension, the use of antiplatelet and/or anticoagulant therapy and faulty puncture techniques are independent risk factors for FAPs