title: Efficacy and safety of percutaneous treatment of iatrogenic femoral artery pseudoaneurysm by biodegradable collagen injection.
abstract: OBJECTIVES; The goal of this study was to assess the safety and efficacy of femoral artery pseudoaneurysm (FAP) closure by collagen injection. BACKGROUND; The FAP is an infrequent but troublesome complication after percutaneous transfemoral catheter procedures. If ultrasound-guided compression repair (UGCR) fails, vascular surgery is indicated. We have developed a less invasive method to close FAPs percutaneously by injecting collagen and, thus, inducing clotting within the aneurysm.
  
  
  METHODS
  Via a 9F needle or 11F sheath, a biodegradable adhesive bovine collagen is injected percutaneously into the FAP, guided by angiography from the contralateral site.
  
  
  RESULTS
  From 1993 to 2000, compression and UGCR had failed to obliterate 110 FAPs. These patients have been treated by collagen injection. Mean age of the patients was 65.6 +/- 10.2 years (range: 32 to 85 years), and 50% were women. Immediate closure of the FAP was achieved in 107/110 patients (97.3%) without any complication or adverse effect. In one patient the collagen could not be applied due to unfavorable anatomy. One patient needed a second session of collagen injection. In one patient too much collagen was inserted, which resulted in external compression of the artery, and surgical intervention was required. The overall success rate was 108/110 (98%, 95% confidence interval: 93.5% to 99.8%). Among the patients with successful procedures, there were no recurrences during six months follow-up.
  
  
  CONCLUSIONS
  The percutaneous treatment of iatrogenic FAP, by injection with collagen, is an effective and safe strategy. This method provides an excellent therapeutic alternative to the traditional surgical management.
authors.affiliation: Heart Lung Center, Utrecht, The Netherlands. khamraoui@freeler.nl
authors.forename: Karim
authors.initials: K
authors.lastname: Hamraoui
authors.forename: Sjef M P G
authors.initials: SM
authors.lastname: Ernst
authors.forename: Pascal F H M
authors.initials: PF
authors.lastname: van Dessel
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: ten Berg
authors.forename: Maarten Jan
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Wybren
authors.initials: W
authors.lastname: Jaarsma
authors.forename: Thijs H W
authors.initials: TH
authors.lastname: Plokker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000188:drug therapy* / Q000378:metabolism*; D006328:Cardiac Catheterization; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D005263:Femoral Artery / Q000737:chemistry* / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016896:Treatment Outcome
chemical_list: D003094:Collagen