Background: Catheter intervention is occasionally complicated by a pseudoaneurysm at the puncture site. Although the feasibility of echo-guided repair of a pseudoaneurysm has been reported, this method does not always repair the pseudoaneurysm. We hypothesized that if the communication to the artery could be effectively closed by pin-point compression, the clot that forms in the residual lumen would effectively cover the communication. We studied the safety and efficacy of the echo-guided pinpoint compression procedure for repairing a pseudoaneurysm. Methods: Ten consecutive patients with a pseudoaneurysm were enrolled. We determined the site of communication by echography with a high-frequency linear probe. We performed pin-point compression on the communication point with the right index finger, and we confirmed closure of the communication by color Doppler. During compression, we monitored echo images to confirm clot formation. Results: A pseudoaneurysm was located on the femoral artery in 6 patients and on the brachial artery in 4 patients. The sizes of the pseudoaneurysms ranged from 13 to 40 mm in diameter. We successfully closed the communication with one-finger compression in all patients. During the compression, we observed clot formation in the residual lumen of the pseudoaneurysm in all patients by echography. The duration of compression ranged from 5 to 40 minutes (mean, 18 minutes). We succeeded in repairing the pseudoaneurysm in all patients using this method. The success of the procedure was also confirmed 24 hours later in all patients. Conclusions: Echo-guided pin-point compression of the communication might be an effective technique for repairing a pseudoaneurysm at the puncture site, and echography is useful for confirming the success of the procedure.
A pseudoaneurysm is a rare complication of a catheter examination or intervention. It is a hematoma that forms as the result of a leaking hole at the puncture site of the artery and is covered by surrounding connective tissues [
Surgery is the gold-standard treatment, but most patients hope for a less invasive treatment. One of the less invasive options is ultrasound-guided compression (
in consecutive patients with post-procedural arterial pseudoaneuryms to study its safety and clinical efficacy.
In the period from April 2006 to July 2010, 4347 patients underwent catheter examination or intervention in our hospital using the radial artery approach in 2800 patients, brachial artery approach in 356 patients and femoral artery approach in 1191 patients. Ten patients (0.2%) suffered from pseudoaneurysms and underwent the revised procedure.
Diagnosis of pseudoaneurysm was made with an echo apparatus equipped with a high-frequency linear probe (3 - 13 MHz) and a color Doppler imaging technique (
Antiplatelet and/or anticoagulant therapies were continued. After identifying the communication to the artery by echography, the right index finger was placed on the pseudoaneurysm just above the communication point (