Management Plan of Post-Angiography False Aneurysms of the Groin

Abstract

Background: False aneurysm (FA) of the groin is a potentially serious complication of angiographic procedures. We developed a management plan at St. George's Hospital, and prospectively applied it to 14 consecutive cases over a period of one year. Patients and Methods: This report is a prospective cohort study of post-angiography false aneurysms-. Fourteen patients with groin FA presented to the vascular team between October 1995 and September 1996 (0.2% of 6926 angiographic procedures). Nine of the 14 patients were fully anticoagulated at the time of treatment. Ultrasoundguided compression (USGC) was tried in 11 patients and was considered inappropriate in three. Embolization was attempted in four patients and surgery was needed in seven patients. Results: The initial angiographic procedure was therapeutic in nine and diagnostic in five patients. The median maximal dimension of the FA was 3 cm (range 2-5). USGC was successful in three patients and failed in eight, seven of them fully anticoagulated at the time of compression. Embolization of the FA was tried in four patients; all were anticoagulated, and embolization was successful. Surgery was required in seven patients, one with infected groin and bleeding, another with FA at the site of a groin graft anastomosis, three with concomitant evacuation of large groin hematomas, one who refused further angiographic procedures, and one who needed prolonged full anticoagulation before the availability of the embolization. The operation was successful in all the patients except one, who died of myocardial infarction 24 hours after successful surgical closure of a FA. Conclusion: FA can be managed in a step-wise manner, starting with the noninvasive USGC, embolization and surgery. Surgery is indicated if evacuation of a large hematoma is required, or the presence of infection is suspected. Emergency surgery is indicated for bleeding or imminent rupture.

Non Surgical Management of Pseudoaneurysms

“…The risk factors for development of pseudoaneurysms of femoral artery comprise of obesity, use of thrombolytic agents, antegrade puncture, heavily calcified arteries, repeated multiple punctures and low puncture site [4]. The incidence varies in different reports being as low as 0.8% in large retrospective series [5]. Katzenschlager et al [6], from series of 581 procedures, showed that the incidence of 14% of pseudoaneurysms went down to 1.1%, by the use of a strict protocol of five minute minimal compression time after cessation of bleeding [6].…”

Transradial Versus Transfemoral Coronary Angiography

“…Pseudoaneurysm; pseudoaneurysmcan is a potentially life threatening complication that particularly occurred in the TF approach. Its incidence in the TF approach was about 0.03% to 0.2% [24]. But it seems to be more prevalent in the era of intervention.…”