Ultrasound-Guided Nonsurgical Closure of Postangiographic Femoral Artery Injuries

Abstract

Postcatheterization injuries at the vascular access site include pseudoaneurysms and arteriovenous fistulas. Traditional treatment of this complication has been surgical repair. This study describes a recently developed method for closing femoral pseudoaneurysms and arteriovenous fistulas by using external compression guided by Doppler color flow imaging. Thirty-six femoral artery injuries (31 pseudoaneurysms, 5 arteriovenous fistulas) were detected by color flow imaging in 35 patients with enlarging groin hematomas and/or groin bruits. All patients underwent a full trial of compression therapy, with an extended compression time limit of 240 minutes and a tag-team approach of two operators to overcome manual fatiguing. The mechanical compression was titrated to obliterate the vascular tracts to the aneurysms or of the arteriovenous fistulas and to maintain an adequate flow in the femoral artery, as far as possible. All postangiographic pseudoaneurysms were successfully treated with a compression time ranging from 10 to 110 minutes, even in patients receiving prolonged anticoagulant therapy. Follow-up ultrasound examination the following morning and 4 to 5 days later confirmed a continued closure in all patients, without side effects such as venous thrombosis or ischemia. In arteriovenous fistulas, compression therapy was successful in two cases without complications or recurrences during follow-up. This study demonstrates that Doppler color flow ultrasound-guided compression of postangiographic femoral artery injuries is a safe and technically simple device and may be implemented as a cost-effective, first-line treatment, with a high rate of success in pseudoaneurysms.

Ultrasound-Guided Nonsurgical Closure of Postangiographic Femoral Pseudoaneurysm

“…9 Doppler features of an AVF include a region of aliasing interposed between an artery and vein with increased diastolic flow in the artery and turbulent flow within the vein. 8…”

“…9 Doppler features of an AVF include a region of aliasing interposed between an artery and vein with increased diastolic fl ow in the artery and turbulent fl ow within the vein. 8 Untreated PSA can lead to progressive lesion enlargement, infection, compression neuropathy, and rupture. 12 Until the early 1990s, surgery was the only treatment available for PSA and AVF closure.…”

“…[5][6][7] However, US-guided compression (USGC) retains a high success rate, 6,7 and in absence of the UGTI facilities, it is a useful substitute for inducing thrombosis in the PSA and closing the arteriovenous fi stula (AVF) tract, with good results. 8…”

Ultrasound Guided Non Surgical Closure of Post Angiographic Femoral Arteriovenous Fistula (AVF) and Pseudoaneurysm (PSA)

“…Despite ultrasound guided thrombin injection [UGTI ] is an off label use of topical thrombin which is not FDA approved for injection, but it is only the treatment of choice when favorable anatomy is present such as a well defined narrow neck for post catheterization PSA [5 -7]. Ultrasound guided compression [USGC] without thrombin injection retains a high success rate [6,7] and it is a useful substitute for inducing thrombosis in the PSA and closure of AVF tract, with good results [10][11][12][13][14][15][16][17]…”