Transaneurysmal Suturing of Pseudoaneurysm Neck: Novel and Not a Pseudo-Technique for Treatment of Complicated Femoral Pseudoaneurysm.

Introduction  Femoral pseudoaneurysm is one of the common complications following femoral artery catheterization. It poses a significant morbidity and a nonsurgical technique with the utmost low complication risk is warranted. Various methods have been used to treat these pseudoaneurysms including manual compression, ultrasound-guided compression, and percutaneous injection of thrombin or glue. Various novel methods are also being used to treat the pseudoaneurysms, including angioseal closure device, vascular plugs, etc. Cirrhosis poses a separate challenge with deranged coagulation and hyperfibrinolysis, making traditional methods, which are dependent on patients' coagulation cascade, less effective. Materials and Methods  We used a novel technique to treat the complicated femoral pseudoaneurysm using a suture-mediated closure device, Perclose ProGlide system (Abbott Vascular, California, United States). The transaneurysmal approach was used in seven patients. All the patients had acute or chronic liver disease with deranged coagulation. Six patients had femoral arterial access for angiographic procedure while one had a femoral line for intensive care unit monitoring. Compression was done in all the patients, but failed. Percutaneous injection of thrombin was done in two patients. Results  Technical success was achieved in 7/7 (100%) patients. There was instantaneous thrombosis of the pseudoaneurysm, which was confirmed the next day by ultrasound. There were no procedure-related complications. Conclusion  Transaneurysmal closure of the femoral pseudoaneurysm using suture-mediated closure device is a novel and effective, minimally invasive bedside technique that can be used in patients with deranged coagulation.