Predictive factors of complications after surgical repair of iatrogenic femoral pseudoaneurysms.
ABSTRACT The aim of the present study was to identify the predictive factors associated with the development of postoperative complications in patients treated with surgical repair of iatrogenic femoral pseudoaneurysm.
Between July 1992 and October 2009 we identified 92 cases of iatrogenic femoral pseudoaneurysm treated with conventional surgery. Surgical repair was performed via a longitudinal groin incision. A primary suture was sufficient in most patients. Twenty-nine variables were considered and included in the analyses.
Urgent interventions were performed in 47 (51.1%) cases. Complications occurred in 22 (23.9%) patients. Bleeding was the most-frequent complication (n = 12), followed by wound infection (n = 6) and atrial fibrillation (n = 3). Overall, patients differed for age only (75.6 ± 7.9 vs. 69.7 ± 10.1; p = .013). Patients with complications required an intensive care unit stay more frequently than those without complications (36.4% vs. 11.4%; p = .007), as well as a longer hospital stay (12.9 ± 8.4 vs. 7.7 ± 7.7 days; p = .013). Bleeding complications were noted to be more frequent in older patients (76.2 ± 8.5 vs. 70.3 ± 9.90 years; p = .056). Wound infections showed a higher correlation with chronic obstructive pulmonary disease (COPD: 50.0% vs. 15.1%; p = .063).
Bleeding and wound infection were the most frequent complications after surgical repair of iatrogenic femoral pseudoaneurysm. Age and COPD were the most important predictive factors for these complications. Patients with postoperative complications required a longer postoperative hospital stay.
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ABSTRACT: This study was a prospective monocentric study to assess the safety and effectiveness of percutaneous embolization with coils of postcatheterization femoral pseudoaneurysm (PCFP). Seventeen PCFPs of 32-mm mean diameter in 16 patients were embolized while anticoagulant or antiplatelet therapy was maintained. Ultrasound scan-guided compression repair failed at least one time in 13 cases and was contraindicated in the four remaining cases. With ultrasound-Doppler scan guidance, the PCFPs were percutaneously punctured with a 16-gauge intravenous catheter. An angiogram was performed through the catheter to ensure its location within the sac. Stainless steel spring coils with synthetic fibers were introduced within the PCFP with fluoroscopic control. Successful thrombosis was checked with ultrasound-Doppler scan and was repeated at days 1, 30, and 180 when possible. All PCFPs of 32-mm mean diameter were successfully treated with two to nine coils. After embolization, gentle additional compression was necessary for complete occlusion, with a mean duration of 6.3 minutes (range, 0 to 15 minutes), except in one case with treatment with abciximab in which it was 45 minutes. All procedures were uneventful and painless. The mean follow-up period was 9.5 months (range, 1 to 21 months). Two recurrences (11.7%) were observed, and one was successfully treated with a second embolization. Percutaneous embolization with coils appears to be a safe and effective method for treatment of PCFP. It may be performed in patients undergoing anticoagulant or antiplatelet therapy and must be attempted when ultrasound scan-guided compression repair has failed or is contraindicated.Journal of Vascular Surgery 08/2002; 36(1):127-31. · 2.88 Impact Factor
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ABSTRACT: Pseudoaneurysms develop at the site of arterial access when there is failure to establish adequate hemostasis. The number of percutaneous diagnostic and therapeutic coronary and peripheral vascular interventions has increased and with it a commensurate rise in the incidence of pseudoaneurysms is observed. Clinical examination and color-flow duplex ultrasound identify the majority of pseudoaneurysms. Ultrasound-guided thrombin injection has been shown to be the ideal method to treat the vast majority of false aneurysms. In a small number of cases, alternative endovascular techniques or open surgical repair is required.Perspectives in Vascular Surgery and Endovascular Therapy 04/2007; 19(1):58-64.
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ABSTRACT: Femoral artery pseudoaneurysms (PSA or false aneurysm) develop in about 1% of patients undergoing procedures that require femoral artery cannulation. PSA prolong hospitalization, consuming health-care resources, and result in significant morbidity. We designed a study to review the prevalence, risk factors, and treatment of PSA. We performed a retrospective, case-controlled study of patients diagnosed with PSA at a large, urban, tertiary-care teaching hospital. We reviewed 48 patients with PSA for our study. The estimated prevalence of PSA was 0.28%, with identical rates found for procedures done in the interventional radiology department and in the cardiac catheterization suite. Logistic regression identified three independent risk factors for developing PSA: being female (odds ratio 2.62), having an intervention performed (odds ratio 3.22), and not having a closure device used (odds ratio 10.2). Patients with PSA had longer hospital length of stay than that of patients without PSA. We found no statistically significant difference in failure or complication rates for the four treatment options and that spontaneous resolution of PSA does not correlate with its size. Thrombin injection and observation are effective, low-complication treatment options.Annals of Vascular Surgery 10/2003; 17(5):503-8. · 0.99 Impact Factor