ABSTRACT
The common femoral artery is the most frequently used access site for angiographic
procedures in interventional radiology. Potential complications of common femoral
arteriotomy include hematoma formation, pseudoaneurysm, uncontrolled groin or retroperitoneal
bleeding, acute arterial occlusion, dissection, and arteriovenous fistula formation.
In a case such as the one described here, with a common femoral artery dissection
with intraluminal thrombus and vessel occlusion, the complication may have occurred
at the time of access or at the time of closure, with both procedure-associated and
patient-specific risk factors affecting the overall risk of complications. Though
some studies have shown an increased risk of complications with the use of arterial
closure devices, others have found no increase. In any patient with symptoms following
a femoral arteriotomy, rapid diagnosis and treatment is necessary to avoid further
complications. Both patient-specific and procedure-associated risk factors should
be considered prior to arteriotomy and usage of an arterial closure device.
KEYWORDS
Dissection - angiogram - common femoral artery - closure device
REFERENCES
- 1
Tsetis D.
Endovascular treatment of complications of femoral arterial access.
Cardiovasc Intervent Radiol.
2010;
33
(3)
457-468
- 2
Halpern M.
Percutaneous transfemoral arteriography: an analysis of the complications in 1,000
consecutive cases.
Am J Roentgenol Radium Ther Nucl Med.
1964 Oct;
92
918-934
- 3
Muller D W, Shamir K J, Ellis S G, Topol E J.
Peripheral vascular complications after conventional and complex percutaneous coronary
interventional procedures.
Am J Cardiol.
1992;
69
(1)
63-68
- 4
Gardiner Jr G A, Meyerovitz M F, Stokes K R, Clouse M E, Harrington D P, Bettmann M A.
Complications of transluminal angioplasty.
Radiology.
1986;
159
(1)
201-208
- 5
Babu S C, Piccorelli G O, Shah P M, Stein J H, Clauss R H.
Incidence and results of arterial complications among 16,350 patients undergoing cardiac
catheterization.
J Vasc Surg.
1989;
10
(2)
113-116
- 6
Nasser T K, Mohler III E R, Wilensky R L, Hathaway D R.
Peripheral vascular complications following coronary interventional procedures.
Clin Cardiol.
1995;
18
(11)
609-614
- 7
McCann R L, Schwartz L B, Pieper K S.
Vascular complications of cardiac catheterization.
J Vasc Surg.
1991;
14
(3)
375-381
- 8
Omoigui N A, Califf R M, Pieper K et al..
Peripheral vascular complications in the Coronary Angioplasty Versus Excisional Atherectomy
Trial (CAVEAT-I).
J Am Coll Cardiol.
1995;
26
(4)
922-930
- 9
Hieb R A, Neisen M J, Hohenwalter E J, Molnar J A, Rilling W S.
Safety and effectiveness of repeat arterial closure using the AngioSeal device in
patients with hepatic malignancy.
J Vasc Interv Radiol.
2008;
19
(12)
1704-1708
- 10
Spector K S, Lawson W E.
Optimizing safe femoral access during cardiac catheterization.
Catheter Cardiovasc Interv.
2001;
53
(2)
209-212
- 11
Davis C, VanRiper S, Longstreet J, Moscucci M.
Vascular complications of coronary interventions.
Heart Lung.
1997;
26
(2)
118-127
- 12
Abando A, Hood D, Weaver F, Katz S.
The use of the Angioseal device for femoral artery closure.
J Vasc Surg.
2004;
40
(2)
287-290
- 13
Kalapatapu V R, Ali A T, Masroor F, Moursi M M, Eidt J F.
Techniques for managing complications of arterial closure devices.
Vasc Endovascular Surg.
2006;
40
(5)
399-408
- 14
Meyerson S L, Feldman T, Desai T R, Leef J, Schwartz L B, McKinsey J F.
Angiographic access site complications in the era of arterial closure devices.
Vasc Endovascular Surg.
2002;
36
(2)
137-144
- 15
Nikolsky E, Mehran R, Halkin A et al..
Vascular complications associated with arteriotomy closure devices in patients undergoing
percutaneous coronary procedures: a meta-analysis.
J Am Coll Cardiol.
2004;
44
(6)
1200-1209
- 16
Koreny M, Riedmüller E, Nikfardjam M, Siostrzonek P, Müllner M.
Arterial puncture closing devices compared with standard manual compression after
cardiac catheterization: systematic review and meta-analysis.
JAMA.
2004;
291
(3)
350-357
- 17
Biancari F, D'Andrea V, Di Marco C, Savino G, Tiozzo V, Catania A.
Meta-analysis of randomized trials on the efficacy of vascular closure devices after
diagnostic angiography and angioplasty.
Am Heart J.
2010;
159
(4)
518-531
- 18
Kirchhof C, Schickel S, Schmidt-Lucke C, Schmidt-Lucke J A.
Local vascular complications after use of the hemostatic puncture closure device Angio-Seal.
Vasa.
2002;
31
(2)
101-106
- 19
Kadner A, Schmidli J, Schwegler I et al..
Complications associated with the arterial puncture closure device—Angio-Seal.
Vasc Endovascular Surg.
2008;
42
(3)
225-227
- 20
Applegate R J, Rankin K M, Little W C, Kahl F R, Kutcher M A.
Restick following initial Angioseal use.
Catheter Cardiovasc Interv.
2003;
58
(2)
181-184
- 21
Kennedy A, Nag S, Salem R et al..
Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere
brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology
consortium.
Int J Radiat Oncol Biol Phys.
2007;
68
(1)
13-23
Sarah G DeitchM.D.
Department of Radiology, Northwestern University
676 North St., Clair Street, Chicago, IL 60611
eMail: sdeitchnw@gmail.com
