Immediate Ultrasound Confirmation With Rescue Compression for Femoral Hemostasis After Endovascular Therapy for Lower Extremity Artery Disease.

BACKGROUND

Femoral artery pseudoaneurysm (FAP) is a recognized complication following endovascular therapy (EVT). Routine ultrasound surveillance has been criticized for inflating reported FAP incidence (surveillance bias). We hypothesized that ultrasound could be repurposed from passive surveillance to an active "confirmation and rescue" strategy to detect and correct incomplete hemostasis immediately.

METHODS AND

RESULTS

We retrospectively analyzed 1002 consecutive patients undergoing femoral access EVT for lower extremity artery disease. The hemostasis protocol consisted of manual compression followed by immediate bedside Doppler ultrasound. If residual flow or hematoma expansion was detected, rescue compression was performed until hemostasis was confirmed. A mandatory follow-up ultrasound was performed the next morning. The overall FAP incidence was 1.0% (10/1002), which was within the lower range of rates reported in prior EVT series. Of the 10 cases, 8 were detected on next-morning ultrasound and 2 (0.2%) presented as delayed events at 5 and 39 days. Thrombin injection was required in 3 cases; the remaining 7 were managed by compression alone. No patient required surgical repair.

CONCLUSIONS

Immediate ultrasound confirmation with rescue compression was associated with a low FAP incidence in a high-risk EVT population. Most events were managed without surgery, suggesting a potential practical advantage over passive surveillance alone.Clinical ImpactThis study describes a practical hemostasis protocol that repurposes bedside ultrasound from passive next-day surveillance to active immediate confirmation with rescue compression after femoral access endovascular therapy. Over 60% of puncture sites required additional compression that standard manual compression alone would not have objectively identified, yet the overall pseudoaneurysm rate was 1.0%, with no surgical repairs. This protocol requires no specialized equipment beyond a standard duplex ultrasound and may be implementable in catheterization laboratories where such ultrasound is available, offering a potentially practical approach to hemostasis assessment in peripheral endovascular practice.