Femoral artery pseudoaneurysm after carotid artery stenting

Abstract

Rationale:Pseudoaneurysm, the most common complication of femoral artery catheterization, involves the formation of a space between the lumen and the surrounding fibrous tissue through the damaged arterial wall. In patients treated with antiplatelet and anticoagulant agents, the incidence of vascular complications increases with the increasing use of minimally invasive procedures.Patient concerns:We experienced 2 cases of procedure-induced pseudoaneurysms. A 79-year-old man with right hemiparesis visited our hospital. Brain magnetic resonance imaging showed acute left middle cerebral artery territory infarction and severe stenosis of the left proximal carotid artery. The patient was prescribed apixaban and underwent carotid stenting through the right femoral artery. Hematoma and tenderness were observed in the right inguinal region after the procedure. The hemoglobin level decreased from 16.9 g/dL to 9.4 g/dL. Another 78-year-old man with left common carotid artery stenosis was admitted. We performed stent implantation through the right femoral artery and administered aspirin and clopidogrel. After the procedure, hematoma and tenderness of the puncture site were observed. The hemoglobin level decreased from 14.5 g/dL to 10.9 g/dL.Diagnosis:Emergency computed tomography confirmed a pseudoaneurysm with a massive hematoma in the right inguinal area. The patients were diagnosed with infection-associated right pseudoaneurysm for which an emergency puncture site repair was performed.Interventions:We performed resection of pseudoaneurysm and repaired puncture site.Outcomes:The hemoglobin level was stabilized postoperatively and vital sign remained stable.Lessons:Pseudoaneurysm is an important complication of femoral artery puncture. The use of a hemostatic device was not superior to manual compression, and the incidence of this complication was significantly higher in patients who received anticoagulant or antiplatelet agents. A pseudoaneurysm may cause a bad prognosis. Therefore, the early detection of pseudoaneurysm and immediate treatment after femoral arterial puncture are needed.

Ultrasound of Pancreaticoduodenal Pseudoaneurysm without Obvious Cause, A Case Report

“…As is known, CT angiography is the gold standard for diagnosing pseudoaneurysms, However, due to the convenience and noninvasiveness, ultrasound has gradually become the first imaging method for diagnosing pseudoaneurysms [6,7].…”

Incidence of and predisposing factors for pseudoaneurysm formation in a high-volume cardiovascular center

“…The femoral approach is still widely used, especially when the procedure requires a large sheath (e.g., BAV, TAVI). Additionally, most lower extremity interventions are performed through the common femoral artery [ 24 ]. The incidence of femoral PSA is 0.05–2% after peripheral artery or coronary artery diagnostic catheterizations [ 25 ] and 2–6% after therapeutic interventions [ 7 ].…”

Case report: Successful and effective percutaneous closure of a deep femoral artery pseudoaneurysm using proglide device

“…Pseudoaneurysm, an encapsulated hematoma that is connected to the arterial puncture site, is the most common complication during the interventional treatment of cardiovascular disease (1). In clinical, pseudoaneurysm frequently occurs due to a low puncture site and insufficient angiopressure support after catheter removal (2).…”