Faculté des sciences

Sealing pseudo-aneurysms of the femoral artery with saline injection: a new technique

Périard, Daniel ; Rey Meyer, Marie-Antoinette ; Hayoz, Daniel ; Cook, Stéphane

In: EuroIntervention, 2012, vol. 7, no. 10, p. 1206-1209

Aims: Pseudo-aneurysm (PA) of the femoral artery is the most frequent complication after diagnostic or therapeutic catheterisation. PA may manifest with large and painful haematoma or compression of the adja-cent nerve and vein. Among several therapeutic approaches, compression by injection of saline around the neck is a recent and promising method. To explore compression with saline as an... Plus

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    Summary
    Aims: Pseudo-aneurysm (PA) of the femoral artery is the most frequent complication after diagnostic or therapeutic catheterisation. PA may manifest with large and painful haematoma or compression of the adja-cent nerve and vein. Among several therapeutic approaches, compression by injection of saline around the neck is a recent and promising method. To explore compression with saline as an alternative treatment for iatrogenic femoral artery PA was the aim of this study.Methods and results: From December 2009 to January 2011, all consecutive patients with symptomatic PA were included in this study. After ultrasonic assessment, the PA neck was occluded by injection of a saline/lidocaïne (0.2%) mixture in the soft tissue at its vicinity, followed by a short echo-guided compression. Out-come was assessed at one and 30 days by duplex sonography. Eleven patients with PA requiring immediate treatment were included. All patients had at least one PA cavity. Moreover, four patients had multiple pulsa-tile cavities and seven patients had large thigh or abdominal haematoma, with either active bleeding, com-pression of adjacent organ or hypotension. Three patients had very short PA neck. The mean injected volume was 47±11 ml. The mean compression time until the PA was closed was 6±3 minutes. At one and 30 days, all PA remained occluded without any complication related to the procedure.Conclusions: Saline injection to seal PA is feasible, safe and very effective. The technique is rapid and well tolerated, and allows, after limited training, the closure of very large PA, even in case of emergency. This new technique is more comfortable for the patient and the operator, and surely more economical than thrombin injection or surgical arterial suture.