Femoral artery pseudoaneurysm

Femoral artery pseudoaneurysms are usually iatrogenic as the femoral artery is the vessel of choice for most endovascular arterial interventions.

Aetiology
  • iatrogenic
    • anticoagulation therapy
    • inadequate compression following endovascular intervention
    • improper arterial puncture technique; ideally the common femoral artery should be punctured
    • inadvertent femoral artery branch puncture
    • post surgical
  • intravenous drug use
  • penetrating trauma
Ultrasound

Ultrasound is the quickest and best modality for assessment. Due to the turbulent forward and backwards flow, a characteristic yin-yang sign may be seen on colour flow while a "to and fro" pattern may be seen with pulsed Doppler. Ultrasound can also be used for probe compression (ultrasound guided compression) with real time feedback of the thrombosing pseudoaneurysm.

CT

Unenhanced CT scans may demonstrate a low-attenuation rounded structure arising from the donor artery. Intermediate or high attenuation (haemorrhage) adjacent to the pseudoaneurysm may been seen and indicates pseudoaneurysmal rupture, which may vary in attenuation dependent on being chronic or acute. The pseudoaneurysmal wall is usually smooth and well defined except in a mycotic pseudoaneurysm, where the wall can be thickened, irregular, or ill-defined. 

CT angiography

May demonstrate a contrast filled sac. However, the entire pseudoaneurysm, however, may not fill with contrast material. If a low-attenuation area remains within the pseudoaneurysm, it usually indicates partial thrombosis 2. A communication with a donor artery adjacent to the pseudoaneurysm can usually be seen.

Treatment options include 2

  • surgical repair
  • ultrasound guided compression
  • ultrasound guided thrombin injection
  • endovascular therapy: stent-graft placement

At the time of writing, the success rate of thrombin injection (89-96%) is considered to be much higher than with compression (74-78%) 1-3,4.

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Article Information

rID: 18591
Synonyms or Alternate Spellings:
  • Femoral artery false aneurysm
  • Femoral arterial false aneurysm
  • Femoral artery false aneurysms
  • Femoral artery pseudoaneurysms
  • Femoral arterial pseudoaneurysms

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    Case 2: common femoral arterial pseudonaneurysm
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    Case 4: profunda femoral artery pseudoaneurysm
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