Femoral artery pseudoaneurysm
Updates to Article Attributes
Femoral artery pseudoaneurysms are usually iatrogenic as the femoral artery is the vessel of choice for most endovascular arterial interventions.
Pathology
CausesAetiology
- iatrogenic
- anticoagulation therapy
- inadequate compression following endovascular intervention
- improper arterial puncture technique; ideally the common femoral artery should be
puncturepunctured - inadvertent femoral artery branch puncture
- post surgical
- intravenous drug use
- penetrating trauma
Radiographic features
Ultrasound
Ultrasound is the quickest and best modality for assessment. Due to the turbulent forward and backward 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 dependant 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 is adjacent to the pseudoaneurysm can usually be seen.
Treatment and prognosis
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(89-96%) is considered to be much higher than with compression (74-78%) 1-3,4.
See also
-<p><strong>Femoral artery pseudoaneurysms</strong> are usually iatrogenic as the femoral artery is the vessel of choice for most endovascular arterial interventions.</p><h4>Pathology</h4><h5>Causes</h5><ul>- +<p><strong>Femoral artery pseudoaneurysms</strong> are usually iatrogenic as the femoral artery is the vessel of choice for most endovascular arterial interventions.</p><h4>Pathology</h4><h5>Aetiology</h5><ul>
-<li>improper arterial puncture technique; ideally the common femoral artery should be puncture</li>- +<li>improper arterial puncture technique; ideally the <a title="Common femoral artery" href="/articles/common-femoral-artery">common femoral artery</a> should be punctured</li>
-</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Ultrasound is the quickest and best modality for assessment. Due to the turbulent forward and backward flow, a characteristic <a href="/articles/yin-yang-sign-1">yin-yang sign</a> 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.</p><h5>CT</h5><p>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 dependant 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. </p><h6>CT angiography</h6><p>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 <sup>2</sup>. A communication with a donor artery is adjacent to the pseudoaneurysm can usually be seen.</p><h4>Treatment and prognosis</h4><p>Treatment options include<sup> 2</sup>:</p><ul>- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Ultrasound is the quickest and best modality for assessment. Due to the turbulent forward and backward flow, a characteristic <a href="/articles/yin-yang-sign-1">yin-yang sign</a> 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.</p><h5>CT</h5><p>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 dependant 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. </p><h6>CT angiography</h6><p>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 <sup>2</sup>. A communication with a donor artery is adjacent to the pseudoaneurysm can usually be seen.</p><h4>Treatment and prognosis</h4><p>Treatment options include<sup> 2</sup></p><ul>
-</ul><p>At the time of writing the success rate of thrombin injection (~89-96%) is considered to be much higher than with compression (74-78%) <sup>1-3,4</sup>.</p><h4>See also</h4><ul><li><a href="/articles/false-aneurysm">pseudoaneurysm</a></li></ul>- +</ul><p>At the time of writing the success rate of thrombin injection (89-96%) is considered to be much higher than with compression (74-78%) <sup>1-3,4</sup>.</p><h4>See also</h4><ul><li><a href="/articles/false-aneurysm">pseudoaneurysm</a></li></ul>
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