Neurovascular Cases

  • The common femoral artery at the mid-point of the bony femoral head is a regular access site for endovascular procedures. Below this point, the common femoral artery bifurcates into the superficial femoral and profunda femoral arteries.
  • A puncture site that is too high, especially if it is above the inguinal ligament, can → ↑ risk of retroperitoneal hematoma. When puncture is too high, direct pressure cannot be meaningfully applied at the puncture site.
  • In addition to bruising, bleeding, and arterial dissection, one possible access complication is the development of an iatrogenic pseudoaneurysm.
  • An iatrogenic pseudoaneurysm at the common femoral artery refers to a blood filled sac in which the walls of the sac are actually the surrounding soft tissues, rather than true vessel wall.
  • Iatrogenic pseudoaneurysm is a rare complication. If they are small, most such pseudoaneurysms spontaneously thrombose within a month’s time. Other treatment options include ultrasound guided compression, thrombin injection (to accelerate thrombosis), or open surgical cut down and repair.

Right common femoral artery injection demonstrates a 2 cm pseudoaneurysm (in the setting of a recent angiographic procedure). There is brisk runoff into both the superficial femoral and profunda femoral arteries.

In addition to the pseudoaneurysm, there is also a large hematoma in the right anterior thigh.

Ultrasound is useful to guide thrombin injection.