femoral pseudoaneurysms requiring surgical treatment

objectives: the aim of this retrospective observational study was to identify local and clinical factors related to the need of surgical repair. patients and 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. 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. conclusions: technical puncture problems were identified in 2/3 of patients requiring open surgery.