D-dimer testing in the diagnosis of transfemoral pseudoaneurysm after percutaneous transluminal procedures.
OBJECTIVE
Pseudoaneurysms are characterized by extravascular circulation and therefore may lead to an activation of the coagulation cascade. We investigated d-dimer levels in patients with and without postcatheterization femoral pseudoaneurysms and hypothesized that d-dimer levels correlate with the presence of pseudoaneurysms at the vascular access site.


METHODS
Patients with clinical suspected groin pseudoaneurysms after transluminal procedures were eligible. We compared prospectively-collected laboratory values of quantitative d-dimer testing in patients with and without pseudoaneurysms as assessed by color-coded duplex sonography. Furthermore, we measured the peak systolic velocity at the arterial fistula of each pseudoaneurysm.


RESULTS
In 48 (40%) of 120 consecutive patients, a pseudoaneurysm was found. The level of d-dimer values was significantly higher in patients with postcatheterization femoral pseudoaneurysms compared with controls (1.9 microg/mL [interquartile range (IQR), 1.34-2.78 microg/mL] vs 0.8 microg/mL [IQR, 0.53-1.14 microg/mL]; P < .001). Values of d-dimer below 0.67 microg/mL have been calculated with a sensitivity of 94% (87%-100%), a specificity of 38% (27%-50%), a positive predictive value of 50% (40%-60%), a negative predictive value of 90% (82%-99%), and a likelihood ratio of 1.52 (1.25-1.85) with regard to the presence of pseudoaneurysms. We also found a significant correlation of the peak systolic velocity at the arterial fistula and increasing d-dimer levels (r = 0.98, P < .0001).


CONCLUSIONS
We found a significantly higher level of d-dimer values in patients with femoral pseudoaneurysms at the vascular access site. Therefore, d-dimer levels could be a potential serological marker in the diagnosis of pseudoaneurysms. A confirmation is warranted in a larger patient sample.
Hoke
Matthias
M
Department of Angiology, Medical University, Vienna, Austria. matthias.hoke@meduniwien.ac.at
Koppensteiner
Renate
R
Schillinger
Martin
M
Haumer
Markus
M
Minar
Erich
E
Wiesbauer
Franz
F
Huber
Christian D
CD
Mlekusch
Wolfgang
W
D000368:Aged; D017541:Aneurysm, False / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D015854:Up-Regulation; D016157:Vascular Fistula / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D