Ultrasound-guided compression of femoral pseudoaneurysm: an audit of practice

Objective. To audit the practice of ultrasound-guided compression of femoral pseudoaneurysm in a specialist cardiac hospital. Background. Femoral pseudoaneurysm is an important complication of invasive cardiac procedures. This may require surgical repair but more recently ultrasound-guided compression for ablating pseudoaneurysms has been described. We investigated the success of such a procedure. Methods and Results. In a 26-month period, 56 patients were referred for ultrasound scanning to exclude the formation of a femoral pseudoaneurysm following transfemoral cardiac procedures. During this period, 5756 diagnostic cardiac catherisations and 1165 coronary angioplasties were performed in our hospital (total of 6921 procedures). Of the 56 patients, 20 patients (0.3% of 6921) were found to have a pseudoaneurysm. Ultrasound-guided compression was attempted in 11 patients and was successful in 7 patients (64%). Of the patients who had failed ultrasound-guided compression, 2 proceeded to surgical closure and 2 were treated conservatively with compression stockings to facilitate thrombosis of the pseudoaneurysm. Of those who did not have an attempted ultrasound-guided compression of the pseudoaneurysm (n=9), a conservative approach consisting of resting the leg was adopted to facilitate spontaneous thrombosis of the pseudoaneurysm; repeat ultrasound scanning was needed for follow-up and 1 patient required surgical closure in this group. Conclusions. In patients with a femoral pseudoaneurysm following an invasive cardiac procedure, ultrasound-guided compression may be useful as an immediate step to ablate the pseudoaneurysm. This avoids either prolonged leg rest and repeated ultrasound scanning or surgical intervention. However, ultrasound-guided compression is not always successful; in these patients, a period of conservative management with repeat ultrasound scanning is appropriate to allow for the possible spontaneous thrombosis of the pseudoaneurysm. Surgical closure is needed in those patients whose pseudoaneurysm is enlarging, painful or remain patent.