Over a 14-month period patients undergoing 144 percutaneous transluminal coronary angioplasty procedures were evaluated for the presence of complications at the femoral
puncture site. After percutaneous transluminal coronary angioplasty each patient was examined by a surgeon, and then a color-flow duplex scan of the groin was obtained. On the initial scan eight
pseudoaneurysms, three
arteriovenous fistulas, one combined
arteriovenous fistula-
pseudoaneurysm, and one thrombosed superficial femoral artery were detected for a major vascular complication rate of 9%.
Pseudoaneurysm formation was associated with the use of
heparin after removal of the arterial sheath. Seven
pseudoaneurysms (initial extravascular cavity size range 1.3 to 3.5 cm) were followed with weekly duplex scans, and all thrombosed spontaneously within 4 weeks of detection. The three patients with isolated
arteriovenous fistulas were each followed for at least 8 weeks, and the
arteriovenous fistulas persisted. Early surgical intervention for postcatheterization femoral
pseudoaneurysms is usually unnecessary as
thrombosis often occurs spontaneously. We would advocate an operative approach for
pseudoaneurysms that are symptomatic, expanding, or associated with large
hematomas. Iatrogenic femoral
arteriovenous fistulas should be considered for elective repair, but this may be delayed for several weeks without adverse sequelae.