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KEY FACTS
Terminology
Procedure
TERMINOLOGY
Definitions
- Hematoma: Extravascular blood collection from continued bleeding at access site
- Most common minor complication
- Incidence of up to 5% (but < 1% severe)
- Extremity: Involving common femoral, brachial, or axillary arteries
- Small: Subcutaneous perivascular soft tissues
- Mild discomfort, ecchymosis
- Self-limited, conservative treatment
- Large: Extensively involves subcutaneous tissues
- Severe groin/arm pain, massive swelling
- May cause limb ischemia, nerve compression, or skin necrosis
- Drainage vs. endovascular or surgical treatment
- Small: Subcutaneous perivascular soft tissues
- Retroperitoneal: Extension into retroperitoneal soft tissues of pelvis/abdomen
- Associated with double wall and high femoral punctures
- May cause hemodynamic compromise and death
- Exclude/address possible active bleed
- Arterial bleed → angiography and embolization
- Venous bleed → reverse anticoagulants, consult surgery
- Most common minor complication
- Pseudoaneurysm (PSA): Contained arterial "rupture" at access site
- Most common major complication
- Incidence: 0.05-2.00% after diagnostic catheterization
- Increases to 2-6% when intervention performed
- Occurs when arterial puncture does not adequately seal
- Pulsatile blood tracks into, and is contained in, perivascular space; assumes sac-like configuration
- Does not contain all 3 layers of arterial wall
- Connecting tract persists between PSA and feeding vessel (usually common femoral artery)
- Pulsatile blood tracks into, and is contained in, perivascular space; assumes sac-like configuration
- Variable size and severity
- < 1 cm: May resolve spontaneously
- > 1 cm: Usually require treatment
- US-guided compression: 1-4 cm
- US-guided thrombin injection: 1-6 cm
- Surgical repair: > 6 cm or after rupture
- Most common major complication
- Arteriovenous fistula (AVF): Direct abnormal communication between artery and vein
- Incidence of up to 0.9%
- May be isolated or associated with PSA
- Variable size and severity
- Small: Up to 1/3 of AVFs may spontaneously close
- Large: May cause hemodynamically significant left-to-right shunt with associated side effects
- Surgical repair
- Endovascular coiling if adequate length
- Arterial covered stent occlusion for nonsurgical candidates
- Arterial dissection: Tear in arterial intima, creating false passage for blood
- Incidence of < 0.5%
- Variable severity
- Focal, nonflow limiting: Usually self-resolve
- Observation, systemic anticoagulation
- Flow limiting: Can cause arterial occlusion/limb ischemia; require treatment
- Focal: Prolonged endovascular balloon occlusion
- Extensive (i.e., involving iliac arteries): Endovascular stent placement
- Focal, nonflow limiting: Usually self-resolve
- Vessel thrombosis: Can occur due to dissection, embolization, or in situ thrombus formation
- Incidence of < 0.5%
- Variable severity
- Nonocclusive: Systemic anticoagulation
- Occlusive: Endovascular thrombolysis vs. open thrombectomy
- Hematoma: Extravascular blood collection from continued bleeding at access site
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Procedure Steps
Alternative Procedures/Therapies
OUTCOMES
Complications
Expected Outcomes
Selected References
- Rizk T et al: Iatrogenic arterial perforation during endovascular interventions. Cureus. 12(8):e10018, 2020
- Gabrielli R et al: Thrombin injection and compression with removable guidewire in the treatment of postcatheterization femoral pseudoaneurysm. J Cardiovasc Surg (Torino). 57(4):510-3, 2016
- Bechara CF et al: Access site management with vascular closure devices for percutaneous transarterial procedures. Erratum in: J Vasc Surg. 54(5):1556, 2011
- Brueck M et al: Percutaneous transluminal dilatation of inadvertent partial or complete occlusion of the femoral artery caused by Angio-Seal deployment for puncture site closure after cardiac catheterization. J Invasive Cardiol. 22(8):353-7, 2010
- Fornaro J et al: Percutaneous balloon fenestration of flow-limiting iatrogenic dissection of the common femoral artery: report of two cases. J Vasc Interv Radiol. 21(7):1115-8, 2010
- Tsetis D: Endovascular treatment of complications of femoral arterial access. Cardiovasc Intervent Radiol. 33(3):457-68, 2010
- Chan YC et al: Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract. 62(10):1604-13, 2008
- Webber GW et al: Contemporary management of postcatheterization pseudoaneurysms. Circulation. 115(20):2666-74, 2007
- Krueger K et al: Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology. 236(3):1104-10, 2005
- Tsutsumi K et al: Pseudoaneurysm of the brachiocephalic artery. Jpn J Thorac Cardiovasc Surg. 53(2):88-92, 2005
- Onal B et al: Postcatheterization femoral arteriovenous fistulas: endovascular treatment with stent-grafts. Cardiovasc Intervent Radiol. 27(5):453-8, 2004
- Kelm M et al: Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: implications for risk stratification and treatment. J Am Coll Cardiol. 40(2):291-7, 2002
- Ruebben A et al: Arteriovenous fistulas induced by femoral arterial catheterization: percutaneous treatment. Radiology. 209(3):729-34, 1998
- Do DD et al: Unusual pseudoaneurysms after catheterization: successful treatment by ultrasound-guided compression. Ultrasound Med Biol. 23(3):377-80, 1997
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References
Tables
Tables
KEY FACTS
Terminology
Procedure
TERMINOLOGY
Definitions
- Hematoma: Extravascular blood collection from continued bleeding at access site
- Most common minor complication
- Incidence of up to 5% (but < 1% severe)
- Extremity: Involving common femoral, brachial, or axillary arteries
- Small: Subcutaneous perivascular soft tissues
- Mild discomfort, ecchymosis
- Self-limited, conservative treatment
- Large: Extensively involves subcutaneous tissues
- Severe groin/arm pain, massive swelling
- May cause limb ischemia, nerve compression, or skin necrosis
- Drainage vs. endovascular or surgical treatment
- Small: Subcutaneous perivascular soft tissues
- Retroperitoneal: Extension into retroperitoneal soft tissues of pelvis/abdomen
- Associated with double wall and high femoral punctures
- May cause hemodynamic compromise and death
- Exclude/address possible active bleed
- Arterial bleed → angiography and embolization
- Venous bleed → reverse anticoagulants, consult surgery
- Most common minor complication
- Pseudoaneurysm (PSA): Contained arterial "rupture" at access site
- Most common major complication
- Incidence: 0.05-2.00% after diagnostic catheterization
- Increases to 2-6% when intervention performed
- Occurs when arterial puncture does not adequately seal
- Pulsatile blood tracks into, and is contained in, perivascular space; assumes sac-like configuration
- Does not contain all 3 layers of arterial wall
- Connecting tract persists between PSA and feeding vessel (usually common femoral artery)
- Pulsatile blood tracks into, and is contained in, perivascular space; assumes sac-like configuration
- Variable size and severity
- < 1 cm: May resolve spontaneously
- > 1 cm: Usually require treatment
- US-guided compression: 1-4 cm
- US-guided thrombin injection: 1-6 cm
- Surgical repair: > 6 cm or after rupture
- Most common major complication
- Arteriovenous fistula (AVF): Direct abnormal communication between artery and vein
- Incidence of up to 0.9%
- May be isolated or associated with PSA
- Variable size and severity
- Small: Up to 1/3 of AVFs may spontaneously close
- Large: May cause hemodynamically significant left-to-right shunt with associated side effects
- Surgical repair
- Endovascular coiling if adequate length
- Arterial covered stent occlusion for nonsurgical candidates
- Arterial dissection: Tear in arterial intima, creating false passage for blood
- Incidence of < 0.5%
- Variable severity
- Focal, nonflow limiting: Usually self-resolve
- Observation, systemic anticoagulation
- Flow limiting: Can cause arterial occlusion/limb ischemia; require treatment
- Focal: Prolonged endovascular balloon occlusion
- Extensive (i.e., involving iliac arteries): Endovascular stent placement
- Focal, nonflow limiting: Usually self-resolve
- Vessel thrombosis: Can occur due to dissection, embolization, or in situ thrombus formation
- Incidence of < 0.5%
- Variable severity
- Nonocclusive: Systemic anticoagulation
- Occlusive: Endovascular thrombolysis vs. open thrombectomy
- Hematoma: Extravascular blood collection from continued bleeding at access site
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Procedure Steps
Alternative Procedures/Therapies
OUTCOMES
Complications
Expected Outcomes
Selected References
- Rizk T et al: Iatrogenic arterial perforation during endovascular interventions. Cureus. 12(8):e10018, 2020
- Gabrielli R et al: Thrombin injection and compression with removable guidewire in the treatment of postcatheterization femoral pseudoaneurysm. J Cardiovasc Surg (Torino). 57(4):510-3, 2016
- Bechara CF et al: Access site management with vascular closure devices for percutaneous transarterial procedures. Erratum in: J Vasc Surg. 54(5):1556, 2011
- Brueck M et al: Percutaneous transluminal dilatation of inadvertent partial or complete occlusion of the femoral artery caused by Angio-Seal deployment for puncture site closure after cardiac catheterization. J Invasive Cardiol. 22(8):353-7, 2010
- Fornaro J et al: Percutaneous balloon fenestration of flow-limiting iatrogenic dissection of the common femoral artery: report of two cases. J Vasc Interv Radiol. 21(7):1115-8, 2010
- Tsetis D: Endovascular treatment of complications of femoral arterial access. Cardiovasc Intervent Radiol. 33(3):457-68, 2010
- Chan YC et al: Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract. 62(10):1604-13, 2008
- Webber GW et al: Contemporary management of postcatheterization pseudoaneurysms. Circulation. 115(20):2666-74, 2007
- Krueger K et al: Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology. 236(3):1104-10, 2005
- Tsutsumi K et al: Pseudoaneurysm of the brachiocephalic artery. Jpn J Thorac Cardiovasc Surg. 53(2):88-92, 2005
- Onal B et al: Postcatheterization femoral arteriovenous fistulas: endovascular treatment with stent-grafts. Cardiovasc Intervent Radiol. 27(5):453-8, 2004
- Kelm M et al: Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: implications for risk stratification and treatment. J Am Coll Cardiol. 40(2):291-7, 2002
- Ruebben A et al: Arteriovenous fistulas induced by femoral arterial catheterization: percutaneous treatment. Radiology. 209(3):729-34, 1998
- Do DD et al: Unusual pseudoaneurysms after catheterization: successful treatment by ultrasound-guided compression. Ultrasound Med Biol. 23(3):377-80, 1997
