title: D-dimer testing in the diagnosis of transfemoral pseudoaneurysm after percutaneous transluminal procedures.
abstract: 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.
authors.affiliation: Department of Angiology, Medical University, Vienna, Austria. matthias.hoke@meduniwien.ac.at
authors.forename: Matthias
authors.initials: M
authors.lastname: Hoke
authors.forename: Renate
authors.initials: R
authors.lastname: Koppensteiner
authors.forename: Martin
authors.initials: M
authors.lastname: Schillinger
authors.forename: Markus
authors.initials: M
authors.lastname: Haumer
authors.forename: Erich
authors.initials: E
authors.lastname: Minar
authors.forename: Franz
authors.initials: F
authors.lastname: Wiesbauer
authors.forename: Christian D
authors.initials: CD
authors.lastname: Huber
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mlekusch
mesh_terms: 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
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D