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.