P008: IATROGENIC COMMON FEMORAL ARTERY PSEUDOANEURYSM FOLLOWING PELVIC ARTERIAL EMBOLIZATION IN A PATIENT WITH SEVERE THROMBOCYTOPENIA
Sara M Hassan, OMSIII1; Vanessa Samaniego, MD2; Arifa Turkistani, MD2; Taelor Highland, DO2
1Nova Southeastern University KPCOM; 2Department of Family Medicine, Larkin Community Hospital – South Miami Campus, South Miami, FL, USA
Introduction/Background: Femoral artery pseudoaneurysm is a recognized complication of percutaneous arterial catheterization and most commonly occurs following interventional radiology or cardiology procedures. Management strategies are traditionally guided by pseudoaneurysm size and symptom burden, with small lesions often managed conservatively. However, this approach may underestimate clinical risk in patients with significant coagulopathy, infection, or impaired tissue integrity. We present a case in which small femoral pseudoaneurysms posed substantial clinical risk due to severe thrombocytopenia and systemic illness, emphasizing the importance of individualized perioperative assessment beyond size-based management algorithms.
Methods: An 81-year-old male with myelodysplastic syndrome–associated pancytopenia was admitted for severe lower gastrointestinal bleeding. Initial evaluation included computed tomography and colonoscopy, which failed to identify a definitive bleeding source. Due to ongoing hemorrhage and clinical instability, the patient underwent embolization of the rectal and left internal iliac arteries via right common femoral arterial access.
Post-procedural surveillance imaging and duplex ultrasonography were performed following concern for access-site complications. Clinical findings, imaging characteristics, laboratory values, and multidisciplinary management recommendations were reviewed.
Results: Following embolization, imaging identified two right common femoral artery pseudoaneurysms located near the femoral bifurcation, each measuring approximately 0.18 cm with narrow necks and characteristic bidirectional flow on duplex ultrasonography. Although the lesions were well below conventional size thresholds for intervention, the patient exhibited multiple high-risk features including severe thrombocytopenia with platelet counts as low as 32 ×10³/µL, recent major hemorrhage, cachexia with minimal soft-tissue coverage, surrounding hematoma formation, and active infectious complications.
Vascular surgery consultation determined that the risk of pseudoaneurysm expansion and rupture was disproportionately elevated despite small lesion size. Ultrasound-guided pharmacologic thrombin injection therapy was recommended as definitive management. After multidisciplinary discussion, the patient and family declined further invasive intervention and elected to pursue comfort-focused care in the setting of progressive sepsis and hematologic failure.
Discussion/Conclusion: Femoral artery pseudoaneurysm remains one of the most common vascular access-site complications following percutaneous intervention. While lesion size is frequently used to guide management, this case illustrates that size alone may inadequately reflect rupture risk in medically complex patients. Severe thrombocytopenia, impaired coagulation, infection, and limited tissue integrity can significantly alter clinical behavior and therapeutic decision-making.
This case underscores the necessity of individualized perioperative assessment when evaluating vascular access complications, particularly in patients with hematologic disorders. Recognition of high-risk clinical modifiers is essential to prevent adverse outcomes and highlights the limitations of strictly algorithmic management strategies.