title: Femoral pseudoaneurysms requiring surgical treatment.
abstract: BACKGROUND
  Despite use of arterial closure devices (APCDs) and thrombin injection , surgery is needed at times to repair femoral pseudoaneurysms (FPA) in patients undergoing endovascular interventions. We analysed the indications and results of surgical repair in a tertiary referral center performing more than 6.000 angiographies and/or interventions annually.
  
  
  OBJECTIVE
  The aim of this retrospective observational study was to identify local and clinical factors related to the need of surgical repair.
  
  
  METHODS
  In this retrospective study, 122 (0.06%) FPAs treated among 21060 patients over a period of five years were assessed. Patient characteristics and therapeutic procedures were analyzed through hospital records.
  
  
  RESULTS
  There were 15.163 (72%) coronary and 5.897 (27%) peripheral interventions, respectively. In 89 (73%) patients, FPA was successfully treated by ultrasound guided compression (USGC) alone.Thirty-three (28%) patients underwent open surgical repair. Indication for operative treatment was hemodynamic instability in 9 (7%) patients, rapidly expanding haematoma unsuitable for USGC or after unsuccessful USGC in 23 (19%). One (0.8%) patient had an arterio-venous fistula. Intraoperative findings suggest that atypical endovascular access (e.g. deep femoral artery, lateral or medial puncture) and multiple puncture sites and/or laceration of the vessel wall were related to the need for surgery in 22 (67%) cases. Most patients had active antithrombotic therapy. Gender or the nature of procedure (diagnostic vs. intervention) did not increase risk for open repair. One (0.8%) patient died. No amputations were performed. Mean hospital stay of patients undergoing open surgical repair was 11 (range 4-36) days.
  
  
  CONCLUSIONS
  Technical puncture problems were identified in 2/3 of patients requiring open surgery.
authors.affiliation: Academic Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados.
authors.forename: Hannu
authors.initials: H
authors.lastname: Savolainen
authors.affiliation: Swiss Cardiovascular Center, University Hospital, 3010 Berne, Switzerland.
authors.forename: Iris
authors.initials: I
authors.lastname: Baumgartner
authors.affiliation: Swiss Cardiovascular Center, University Hospital, 3010 Berne, Switzerland.
authors.forename: Juerg
authors.initials: J
authors.lastname: Schmidli
authors.affiliation: Swiss Cardiovascular Center, University Hospital, 3010 Berne, Switzerland.
authors.forename: George
authors.initials: G
authors.lastname: Heller
authors.affiliation: Swiss Cardiovascular Center, University Hospital, 3010 Berne, Switzerland.
authors.forename: Do-Dai
authors.initials: DD
authors.lastname: Do
authors.affiliation: Swiss Cardiovascular Center, University Hospital, 3010 Berne, Switzerland.
authors.forename: Torsten
authors.initials: T
authors.lastname: Willenberg
keywords: Angiography; Catheters; Endovascular; Femoral Artery; Indwelling
references.citation: Eur J Vasc Endovasc Surg. 2001 Dec;22(6):542-5
references.pmid: 11735204
references.citation: JAMA. 2004 Jan 21;291(3):350-7
references.pmid: 14734598
references.citation: Am Heart J. 2002 Apr;143(4):612-9
references.pmid: 11923797
references.citation: J Am Soc Echocardiogr. 1997 Apr;10(3):236-45
references.pmid: 9109690
references.citation: J Invasive Cardiol. 2003 Feb;15(2):60-2
references.pmid: 12556615
references.citation: Am J Cardiol. 1998 Jun 15;81(12):1502-5
references.pmid: 9645907
references.citation: Rev Esp Cardiol. 1998 Sep;51(9):750-5
references.pmid: 9803801
references.citation: Heart. 1998 May;79(5):502-4
references.pmid: 9659200
references.citation: Heart. 2003 May;89(5):564
references.pmid: 12695475
references.citation: Vasc Endovascular Surg. 2008 Jun-Jul;42(3):225-7
references.pmid: 18230871
references.citation: J Cardiovasc Surg (Torino). 1998 Jun;39(3):281-5
references.pmid: 9678547
references.citation: Semin Vasc Surg. 1998 Dec;11(4):283-93
references.pmid: 9876035
references.citation: Ann R Coll Surg Engl. 1999 Jan;81(1):23-6
references.pmid: 10325680
references.citation: Eur J Vasc Endovasc Surg. 2004 Apr;27(4):385-8
references.pmid: 15015188
references.citation: Am Surg. 2000 Oct;66(10):937-40; discussion 940-2
references.pmid: 11261620
references.citation: J Cardiol. 1999 Sep;34(3):131-8
references.pmid: 10500973