title: Prediction of iatrogenic pseudoaneurysm after percutaneous endovascular procedures.
abstract: OBJECTIVE
  To prospectively evaluate the accuracy of using physical examination to identify puncture-related groin pseudoaneurysms, as assessed by using duplex ultrasonography (US), after percutaneous transluminal procedures and to prospectively evaluate the association between preinterventional platelet count, antiplatelet medication, and the occurrence of pseudoaneurysms.
  
  
  METHODS
  This study was approved by the local ethics committee, and informed consent was obtained from all patients. The study prospectively included 273 consecutive patients (161 men, 112 women; age range, 34-90 years) who were referred for duplex US evaluation of the inguinal arterial puncture site 1 day after endovascular procedures. Prior to duplex US, all patients underwent physical examination of the groin. In addition, clinical characteristics and preinterventional laboratory parameters were assessed. Statistical significance was determined by using chi2 tests, the Fischer exact test, and unpaired t tests.
  
  
  RESULTS
  Twenty-three pseudoaneurysms were found in 273 patients by using duplex US. Pulsatile groin masses that were detected at physical examination were used to correctly identify all pseudoaneurysms (positive predictive value, 100%; negative predictive value, 100%). Painful pulse palpation had a slightly lower predictive power (positive predictive value, 92% [95% confidence interval: 81%, 100%]; negative predictive value, 100% [95% confidence interval: 100%, 100%]). Other clinical parameters, such as the presence of superficial hematomas, systolic bruits, or nonpulsatile groin masses, had no adequate predictive properties. Interobserver agreement was excellent between observers (97% agreement [95% confidence interval: 92%, 100%]). All patients with pseudoaneurysms had a preprocedural platelet count of less than 200 x 10(9)/L. No subacute complications were observed at the access site in patients with a platelet count of more than 200 x 10(9)/L.
  
  
  CONCLUSIONS
  Physical examination revealed sufficient predictive capability in facilitating the identification of iatrogenic pseudoaneurysms after percutaneous vascular procedures. A platelet count of less than 200 x 10(9)/L was associated with high predictive capability, thereby warranting further assessment in a larger series of patient.
authors.affiliation: Department of Internal Medicine II, Division of Angiology, Vienna General Hospital, Medical University, Währinger Gürtel 18-20, A-1090 Vienna, Austria. wolfgang.mlekusch@meduniwien.ac.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mlekusch
authors.forename: Markus
authors.initials: M
authors.lastname: Haumer
authors.forename: Irene
authors.initials: I
authors.lastname: Mlekusch
authors.forename: Petra
authors.initials: P
authors.lastname: Dick
authors.forename: Sabine
authors.initials: S
authors.lastname: Steiner-Boeker
authors.forename: Andrea
authors.initials: A
authors.lastname: Bartok
authors.forename: Schila
authors.initials: S
authors.lastname: Sabeti
authors.forename: Markus
authors.initials: M
authors.lastname: Exner
authors.forename: Oswald
authors.initials: O
authors.lastname: Wagner
authors.forename: Erich
authors.initials: E
authors.lastname: Minar
authors.forename: Martin
authors.initials: M
authors.lastname: Schillinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000209:etiology*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D018616:Ultrasonography, Doppler, Duplex