Management algorithm for iatrogenic femoral pseudoaneurysm
Management algorithm for iatrogenic femoral pseudoaneurysm
This algorithm shows the authors' approach to the management of IPA. Refer to UpToDate topics on the management of iatrogenic femoral artery pseudoaneurysm for additional details of our approach to treatment and the overall efficacy of these treatments.
IPA: iatrogenic pseudoaneurysm; UGTI: ultrasound-guided thrombin injection; UGC: ultrasound-guided compression; AV: arteriovenous. * Complicated IPA is defined as the presence of any of the following clinical features:
Hemodynamic instability
Neurologic deficit (motor or sensory) or pulse deficit attributable to the IPA
Expanding hematoma
Extensive skin and subcutaneous damage
Concern for soft tissue infection (eg, fever, cellulitis, purulent drainage)
¶ This includes patients taking conventional antiplatelet agents (aspirin, clopidogrel), including dual antiplatelet therapy. Spontaneous resolution is less likely with use of newer-generation antiplatelet agents or direct oral anticoagulants; treatment (rather than observation) may be warranted. Δ UGC can also be tried if there is a concomitant AV fistula. ◊ Minimally invasive treatment can include UGTI (repeat), UGC, or endovascular treatment. Endovascular treatment is rarely indicated but may be considered if the patient is a poor-risk surgical candidate. § Almost all small IPAs thrombose within 3 months; if persistent, minimally invasive treatment is warranted.