Iatrogenic Femoral Artery Pseudoaneurysm.

A small (< 6 cm(3) in volume or 1.8 cm in diameter), uncomplicated iatrogenic femoral artery pseudoaneurysm in a reliable patient not requiring anticoagulation can be safely observed with weekly physical examinations and ultrasound evaluations until full thrombosis is documented. The patient should be informed that any symptoms or complications should be reported to a physician immediately. A pseudoaneurysm associated with limb ischemia, severe infection, neurologic deficit, skin necrosis, rapid expansion, or hemorrhage should be treated surgically. Also, surgery is recommended if less invasive treatment strategies have failed, or if a planned surgical procedure involving the groin is anticipated. Given its high success rate, low complication rate, and cost-effectiveness, ultrasound-guided thrombin injection should be considered as first-line treatment for uncomplicated iatrogenic femoral pseudoaneurysm. Ultrasound-guided compression repair is an effective alternative to thrombin injection, especially in institutions that have little or no experience with thrombin injection. Alternative treatment strategies, such as percutaneous endovascular stenting and perfusion ballooning, are generally not recommended as first-line treatment options, because they have not been studied as extensively as ultrasound-guided compression repair or thrombin injection. If no other options are available, however, these alternative approaches may be appropriate in certain clinical situations.