The Durability of Duplex-Directed Manual Occlusion of Femoral False Aneurysms

Abstract

Duplex-directed manual occlusion (DDMO) has emerged as a first line treatment in selected cases of iatrogenic pseudoaneurysms related to interventional and therapeutic femoral artery cannulations. Early recurrences after successful closure of femoral false aneurysms (FFA) are described in the literature; however, very little long-term follow-up data are available. Therefore, the authors reviewed their experience with DDMO of 45 FFAs between February 1991 and December 1994. Follow-up was arranged to assess the durability of this noninvasive procedure. DDMO was unsuccessful in three of 45 FFAs (6.6%). Symptomatic recurrences of two FFAs were documented by repeat duplex ultrasound at 7 and 20 days post DDMO. Repeat DDMO was successful on one whereas the other required surgical closure. One additional patient experienced persistent groin discomfort despite successful DDMO necessitating surgical evacuation of a large hematoma. Four patients died during the follow-up period. Thirty-five patients with 36 FFAs remained eligible for long-term eval uation. Three were lost to follow-up and six patients were interviewed by phone and denied symptoms suggestive of recurrence but refused further follow-up. Twenty-six patients with a history of 24 FFAs underwent repeat duplex scans. No recurrent FFAs were identified with mean follow-up of 17.5 months (range 1-35). The authors conclude that DDMO is a safe, effective, and durable treatment of iatrogenic femoral false aneurysms.

Successful ultrasonographically guided compression repair of a dialysis fistula pseudoaneurysm.

“…It must be mentioned that most studies found a lower success rate in patients treated with anticoagulants. 1, 13 We did not treat a normal Brescia-Cimino fistula of the forearm but an autogenous fistula of the upper arm. It is possible that such a fistula tolerates a greater compression without risk of a thrombosis.…”