Over a 14-month period patients undergoing 144 percutaneous transluminal coronary
angioplasty procedures were evaluated for the presence of complications at the femoral
puncture site. After percutaneous transluminal coronary angioplasty each patient was
examined by a surgeon, and then a color-flow duplex scan of the groin was obtained.
On the initial scan eight pseudoaneurysms, three arteriovenous fistulas, one combined
arteriovenous fistula-pseudoaneurysm, and one thrombosed superficial femoral artery
were detected for a major vascular complication rate of 9%. Pseudoaneurysm formation
was associated with the use of heparin after removal of the arterial sheath. Seven
pseudoaneurysms (initial extravascular cavity size range 1.3 to 3.5 cm) were followed
with weekly duplex scans, and all thrombosed spontaneously within 4 weeks of detection.
The three patients with isolated arteriovenous fistulas were each followed for at
least 8 weeks, and the arteriovenous fistulas persisted. Early surgical intervention
for postcatheterization femoral pseudoaneurysms is usually unnecessary as thrombosis
often occurs spontaneously. We would advocate an operative approach for pseudoaneurysms
that are symptomatic, expanding, or associated with large hematomas. Iatrogenic femoral
arteriovenous fistulas should be considered for elective repair, but this may be delayed
for several weeks without adverse sequelae.