Ultrasound-guided Compression Repair of Post Catheterisation Femoral Artery Pseudoaneurysm: A Retrospective Study from a Tertiary Cardiac Institute TC05-TC09
Dr. Yashpal R Rana,
U N Mehta Institute of Cardiology and Research Centre, Affiliated to B.J. Medical College, Civil Hospital, Asarwa, Ahmedabad-380016, Gujarat, India.
Introduction: Femoral Artery Pseudoaneurysm (FAP) is a rare complication after catheterisation however due to huge workload of interventional procedures in a nodal cardiac institute; they are seen with relatively increasing frequency.
Aim: To share high volume cardiac institute’s experience of Ultrasound-Guided Compression Repair (UGCR) technique, results and probable predictive factors of failed compression.
Materials and Methods: A retrospective study was conducted from 2012 to 2019 in which 310 patients diagnosed with FAP on ultrasound study were enrolled. All the patients who were diagnosed on same day of the procedure were given tight compression bandage and re-evaluated after 24 hours to look for presence or absence of spontaneous thrombosis. Those patients in whom pseudoaneurysm were still present 24 hours after the procedure were given compression. Manual compression was given with a 10 MHz linear probe until complete thrombosis was achieved or maximum four cycles were attempted before labelling patient as failure. In those patients where complete thrombosis was achieved, follow-up study was obtained at 24 hours and after one month to detect any recurrence. All statistical studies were carried out using IBM SPSS program version 20. Quantitative variables were expressed as mean±standard deviation and qualitative variables were expressed as percentage (%).
Results: Out of 310 pseudoaneurysms, 53 of them were of small size and thrombosed spontaneously on 24 hours follow-up and tight compression bandage and seven patients fell in exclusion criteria. Remaining 250 patients were attempted for UGCR. Successful thrombosis of the pseudoaneurysm was achieved in 235 (94%) patients. The mean largest dimension of the pseudoaneurysms sac was 3.5 cm (range 1-8 cm) and mean sac area was 9 cm2 (range 1-36 cm2). The mean length of pseudoaneurysm neck was 11 mm (1-26 mm) while mean width of neck was 2.3 mm (range 0.5-6 mm). The mean compression time of the successful compressions was 26 minutes (range 6-110 min). Successful thrombosis of the pseudoaneurysm was achieved in <60° angle (97.1%) compare to >60° angle (27.3%).
Conclusion: UGCR is a safe, reliable and cost-effective treatment for post catheterisation FAP. Width, and angle of the pseudoaneurysm neck were major predictive factor of technical success.