Management algorithm for iatrogenic femoral pseudoaneurysm

IPA: iatrogenic pseudoaneurysm; UGTI: ultrasound-guided thrombin injection; UGC: ultrasound-guided compression; AV: arteriovenous.
* Complicated IPA is defined as the presence of any of the following clinical features:

• Hemodynamic instability
• Neurologic deficit (motor or sensory) or pulse deficit attributable to the IPA
• Expanding hematoma
• Extensive skin and subcutaneous damage
• Concern for soft tissue infection (eg, fever, cellulitis, purulent drainage)

¶ This includes patients taking conventional antiplatelet agents (aspirin, clopidogrel), including dual antiplatelet therapy. Spontaneous resolution is less likely with use of newer-generation antiplatelet agents or direct oral anticoagulants; treatment (rather than observation) may be warranted.
Δ UGC can also be tried if there is a concomitant AV fistula.
◊ Minimally invasive treatment can include UGTI (repeat), UGC, or endovascular treatment. Endovascular treatment is rarely indicated but may be considered if the patient is a poor-risk surgical candidate.
§ Almost all small IPAs thrombose within 3 months; if persistent, minimally invasive treatment is warranted.