DÄ internationalArchive4/2021Clinical snapshot Pseudoaneurysm Following Transfemoral Percutaneous Aortic Valve Replacement

Clinical Snapshot

Clinical snapshot Pseudoaneurysm Following Transfemoral Percutaneous Aortic Valve Replacement

Dtsch Arztebl Int 2021; 118: 58. DOI: 10.3238/arztebl.m2021.0089

Jud, P; Eibisberger, M

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An 86-year-old female patient developed acute swelling and bulging varicose veins on the right leg. The patient had undergone transfemoral percutaneous aortic valve replacement via a 9-F sheath 2 days previously due to high-grade aortic stenosis. Clinical examination revealed swelling of the right thigh as well as prominent varicose veins on the right great saphenous vein and its side branches. Ultrasound ruled out deep and superficial vein thrombosis; however, a pseudoaneurysm causing venous reflux in the saphenous vein was suspected. Subsequent computed tomography angiography (Figure a, b) confirmed a pseudoaneurysm of the right common femoral artery measuring 3.5 × 2.0 × 3.0 cm (Figure a, red arrow), which was compressing the right common femoral vein (Figure a, white arrow). Following surgical removal of the pseudoaneurysm, the patient was discharged 10 days postoperatively. Pseudoaneurysms occur in up to 7.9% of cases following transfemoral percutaneous aortic valve replacement. Predisposing factors include inadequate postinterventional compression, large sheath diameter, and multiple arterial punctures.

a) Computed tomography angiography of the lower limb arteries (transverse section) with evidence of a pseudoaneurysm (red arrow) that is compressing the right common femoral vein (white arrow). In addition, a medially located infraperitoneal postinterventional hematoma in the pelvic region could be seen displacing the urinary bladder to the contralateral side; b) computed tomography angiography of the pelvic and lower limb ar-teries in the volume rendering technique showing evidence of a pseudoaneurysm of the right common femoral artery, including aneurysmal neck.
Figures
a) Computed tomography angiography of the lower limb arteries (transverse section) with evidence of a pseudoaneurysm (red arrow) that is compressing the right common femoral vein (white arrow). In addition, a medially located infraperitoneal postinterventional hematoma in the pelvic region could be seen displacing the urinary bladder to the contralateral side; b) computed tomography angiography of the pelvic and lower limb ar-teries in the volume rendering technique showing evidence of a pseudoaneurysm of the right common femoral artery, including aneurysmal neck.

Dr. med. Philipp Jud, Klinische Abteilung für Angiologie, Universitätsklinik für Innere Medizin der Medizinischen Universität Graz, philipp.jud@medunigraz.at

Dr. med. Martin Eibisberger, Klinische Abteilung für Neuroradiologie, vaskuläre und interventionelle Radiologie, Universitätsklinik für Innere Medizin der Medizinischen Universität Graz

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Jud P, Eibisberger M: Pseudoaneurysm following transfemoral percutaneous aortic valve replacement. Dtsch Arztebl Int 2021; 118: 58. DOI: 10.3238/arztebl.m2021.0089

a) Computed tomography angiography of the lower limb arteries (transverse section) with evidence of a pseudoaneurysm (red arrow) that is compressing the right common femoral vein (white arrow). In addition, a medially located infraperitoneal postinterventional hematoma in the pelvic region could be seen displacing the urinary bladder to the contralateral side; b) computed tomography angiography of the pelvic and lower limb ar-teries in the volume rendering technique showing evidence of a pseudoaneurysm of the right common femoral artery, including aneurysmal neck.
Figures
a) Computed tomography angiography of the lower limb arteries (transverse section) with evidence of a pseudoaneurysm (red arrow) that is compressing the right common femoral vein (white arrow). In addition, a medially located infraperitoneal postinterventional hematoma in the pelvic region could be seen displacing the urinary bladder to the contralateral side; b) computed tomography angiography of the pelvic and lower limb ar-teries in the volume rendering technique showing evidence of a pseudoaneurysm of the right common femoral artery, including aneurysmal neck.
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