Post-catheterization pseudoaneurysm involving the femoral artery
Presentation
right inguinal pain and swelling hardened after cardiac catheterization procedure.
Patient Data
Encapsulated collection located in the subcutaneous tissue at the root of the right thigh (anterior). Well-defined heterogeneous hypoechoic presenting content, intermingled with echogenic beams, suggestive of hematic content (hematoma). For the most part is not identified internal flow on Doppler. In short segment in the set is identified turbulent flow (bidirectional flow), and it is coming through the femoral artery fistula. Note the characteristic yin-yang (red-blue) flow. Normal flow in the right femoral artery.
Skin groin of the patient
Catheterization access still has blood leaking out. There is an extensive subcutaneous hematoma around the groin.
Observation: Photo obtained with patient's permission.
Local vascular anatomy
Gray's anatomy illustration.
Author: 20th U.S. edition of Gray's Anatomy of the Human Body.
Modifications: no modifications
License: This faithful reproduction of a lithograph plate from Gray's Anatomy, a two-dimensional work of art, is not copyrightable in the U.S. as per Bridgeman Art Library v. Corel Corp.; the same is also true in many other countries, including Germany. Unless stated otherwise, it is from the 20th U.S. edition of Gray's Anatomy of the Human Body, originally published in 1918 and therefore lapsed into the public domain. Other copies of Gray's Anatomy can be found on Bartleby and also on Yahoo!
Case Discussion
Post-catheterization pseudoaneurysms involving the femoral artery can lead to significant morbidity; possible sequelae include pain, infection, compression of adjacent structures, rupture, and distal arterial insufficiency1.
Pseudoaneurysms arise from a disruption in arterial wall continuity resulting from inflammation, trauma, or iatrogenic causes such as surgical procedures, percutaneous biopsy, or drainage.
The incidence of post-catheterization pseudoaneurysms, or arteriovenous fistulas involving the femoral artery, has been reported to be 0.02 to 0.2%. Diagnosis of these complications are easily accomplished using ultrasound1.
Observations:
- Photo obtained with patient's permission.
- Diagram obtained from Gray's Anatomy - Public Domain.
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