Treatment options for post-catheterisation femoral pseudoaneurysm closure

Abstract

Background: Femoral artery pseudoaneurysm (FAP) complicates from 1% to 9% of all coronary angiography procedures and contributes to extended hospitalisation as well as patient discomfort.Aim: To compare three main methods of FAP closure which are used nowadays.Methods: Seventy-five subjects (38 females, 37 males, mean age 60.8±10.4 years) with post-catheterisation FAP were studied. The results of three methods of FAP closure - surgical, local compression and thrombin injection, were compared.Results: Between September 2000 and July 2001, fourteen patients developed FAP; in 9 (64%) patients FAP was closed with repeated prolonged compression whereas the remaining 5 (36%) patients required surgical closure of compression-resistant FAP. We observed that FAPs with longer neck (>10 mm) and primary signs of partial spontaneous coagulation were more prone to self-closure as compared to FAPs with short neck and no signs of perimural coagulation (p=0.01). Since July 2001, we introduced ultrasound-guided thrombin injection into FAP sack. The protocol included attempt of closing FAP with probe compression and compression dressing put overnight, and, if unsuccessful, followed by a quick injection of 2 ml of thrombin solution (400-3200 U), guided by ultrasound. During this period, we identified 61 patients with FAP. Out of this group, 5 (8.2%) subjects were referred for surgery without any attempt of thrombin-injection, in 16 (26.2%) patients FAP was closed with probe compression and dressing put overnight, and in the remaining 40 (65.6%) subjects ultrasound-guided thrombin-injection was performed. Thrombin injection into FAP sack caused closure of its cavity and neck in all patients, however, five patients required additional thrombin injection during the same session, and 2 (5.0%) patients - during the next procedure. No peri-procedural complications were observed. The duration of hospital stay shortened from a mean of 26.6±14.5 days in surgically treated patients to 7.9±6.7 in those in whom FAPs were closed with compression, and to 4.6±2.6 days in those treated with thrombin (