Should I go to the emergency department for a possible pseudoaneurysm after a recent cardiac catheterization?

Should You Go to the ER for a Possible Pseudoaneurysm After Cardiac Catheterization?

Yes, you should go to the emergency department immediately if you suspect a pseudoaneurysm after cardiac catheterization, as this is a potentially limb- or life-threatening vascular complication that requires urgent evaluation and treatment. 1

Why This Is Urgent

Pseudoaneurysms represent a disruption in arterial wall continuity and can develop unpredictably with high morbidity and mortality rates if complications occur. 2 After femoral artery catheterization (the typical access site for cardiac catheterization), pseudoaneurysms occur in 0.1% to 0.2% of diagnostic procedures and 3.5% to 5.5% of interventional procedures. 3

Warning Signs to Recognize

You should seek emergency care if you notice any of these findings at your catheterization site:

• A pulsatile mass or swelling at the groin puncture site 3
• A palpable thrill (vibration you can feel) 3
• An audible bruit or "to-and-fro" murmur (whooshing sound) 3
• Pain, swelling, or discoloration in the leg 1
• Any bleeding or expanding hematoma at the access site 3

Potential Complications Requiring Emergency Treatment

Larger pseudoaneurysms (>2 cm) can lead to serious complications including:

• Rupture with life-threatening hemorrhage 3
• Compression of the adjacent femoral vein causing venous thrombosis 3
• Compression of the femoral nerve 3
• Limb-threatening ischemia 1

What Will Happen in the ER

The emergency department will perform urgent diagnostic evaluation:

• Color flow duplex ultrasound is the diagnostic imaging modality of choice and can confirm the pseudoaneurysm, assess its size, show the communication with the femoral artery, and evaluate blood flow patterns 3
• Physical examination to assess for complications 3
• Hemodynamic assessment to determine stability 1

Treatment Options Available

Treatment depends on the size and your clinical stability:

• Small pseudoaneurysms (<2 cm) may clot spontaneously and require only observation 3
• Larger pseudoaneurysms require intervention, which may include:
  • Ultrasound-guided compression 2, 3
  • Ultrasound-guided percutaneous thrombin injection (fairly easy and effective) 1, 2
  • Endovascular techniques (stent graft, coil embolization) 1, 2
  • Surgical repair if other methods fail or in unstable patients 1, 2

Critical Pitfall to Avoid

Do not wait to see if symptoms resolve on their own. Recognition of this condition and prompt treatment are essential to avoid delay in management of this potentially limb- or life-threatening complication. 1 The presentation may vary from being clinically silent to a life-threatening emergency scenario, so early evaluation is crucial. 1