title: Pseudoaneurysm after transpedal arterial access for evaluation and treatment of peripheral arterial disease.
abstract: BACKGROUND
  There has been an increasing use of transpedal arterial access (TPA) for evaluation and treatment of peripheral arterial disease (PAD) over a transfemoral approach (TFA). TPA, it is expected to be associated with better patient comfort, less recovery time and possibly less access site complications compared to standard TFA. Access site complications and pseudoaneurysm (PSA) associated with the TPA have not been previously reported.
  
  
  OBJECTIVE
  Here we report a series of pedal artery PSA related to access site complicating TPA catheterization.
  
  
  METHODS
  We studied 1460 patients with symptomatic PAD who underwent 2236 peripheral diagnostic and/or interventional procedures between 06/2014 and 01/2016 via TPA. Hemostasis was achieved using patent hemostasis technique by a radial artery compression device for 2h. PSA related to the access site were suspected clinically and confirmed with arterial duplex ultrasound.
  
  
  RESULTS
  The incidence of PSA related to any access site was 0.002%. In this series all PSA occurred only in the posterior tibial artery, after an interventional procedure. All patients were treated successfully with thrombin injection with no residual complications.
  
  
  CONCLUSIONS
  PSA associated with TPA is extremely rare and seems to occur exclusively after posterior tibial artery access. It is easily treatable by thrombin injection.
authors.affiliation: Mount Sinai Beth Israel Medical Center, New York, United States of America.
authors.forename: Apurva
authors.initials: A
authors.lastname: Patel
authors.affiliation: Mount Sinai Beth Israel Medical Center, New York, United States of America.
authors.forename: Roosha
authors.initials: R
authors.lastname: Parikh
authors.affiliation: Mount Sinai Beth Israel Medical Center, New York, United States of America; Chinatown Cardiology, P.C., New York, NY.
authors.forename: Yili
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Mount Sinai Beth Israel Medical Center, New York, United States of America; Chinatown Cardiology, P.C., New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Liou
authors.affiliation: Mount Sinai Beth Israel Medical Center, New York, United States of America.
authors.forename: Justin
authors.initials: J
authors.lastname: Ratcliffe
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.affiliation: Mount Sinai Beth Israel Medical Center, New York, United States of America.
authors.forename: Joseph
authors.initials: J
authors.lastname: Puma
authors.affiliation: Mount Sinai Beth Israel Medical Center, New York, United States of America; Chinatown Cardiology, P.C., New York, NY. Electronic address: kwancardio@aol.com.
authors.forename: Tak W
authors.initials: TW
authors.lastname: Kwan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000628:therapy*; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods
chemical_list: D013917:Thrombin
keywords: Peripheral arterial disease; Pseudoaneurysm; Transpedal arterial access; Vascular complication