Predictive Factors For Complications Following Surgical Repair Of Iatrogenic Femoral Pseudoaneurysms

OBJECTIVE:The most catastrophic complication of pseudoaneurysms is rupture. However, several further complication may occur, leading to a prolonged and complicated hospitalization. The aim of the present study was to identify the predictive factors associated to postoperative complications of patients undergoing surgical repair of iatrogenic femoral pseudoaneurysms. METHODS:Between September 1989 and December 2009 we identify 92 cases of iatrogenic femoral pseudoaneurysms. Twenty-nine variables were considered and included in the analysis. pseudoaneurysms treatments included compression under echo-guide, thrombin injections, surgery and simple observation. RESULTS:The study cohort comprised 55 (59.8%) men with a mean age of 71.1 ± 9.9 years (range, 48-88). A therapeutic procedure and a retrograde approach were performed in 64 (69.6%) and 85 (92.4%) cases, respectively. A direct hand compression was adopted in 75 (81.5%) patients, while a percutaneous closure device in the remaining 17 (18.5%). Pseudoaneurysms were predominantly located in the common femoral artery (n = 63, 68.5%), followed by the superficial (n = 26, 28.3%) and the profunda (n = 3, 3.3%) ones, respectively. Mean lesion diameter was 36.5 ± 21.2 mm (range, 15-200). Emergency procedures were carried out in 47 (51.1%) cases. Complications occurred in 22 (23.9%) patients; bleeding was the most-frequent complication (n = 12), followed by wound infection (n = 6), and atrial fibrillation (n = 3). Patients with or without complications differed for age only (75.6 ± 7.9 vs. 69.7 ± 10.1, p = 0.013). As expected, patients with complications required higher rate of intensive care unit stay (36.4% vs. 11.4%, p = 0.007) and a longer hospital stay (12.9 ± 8.4 vs. 7.7 ± 7.7 days, p = 0.013). Patients affected by bleeding were older (76.2 ± 8.5 vs. 70.3 ± 9.90 years, p = 0.056). Wound infections showed a higher correlation with chronic obstructive pulmonary disease (50.0% vs. 15.1%, p = 0.063). For bleeding occurrence, age (OR 1.08; 95%CI 1.01 to 1.16) was the only one independent risk factor, while wound infection was independently predicted by chronic obstructive pulmonary disease (OR 5.62; 95%CI 1.02 to 30.91). CONCLUSIONS:Bleeding and wound infection were the most frequent complications following surgical repair of iatrogenic femoral pseudoaneurysms. Age and chronic obstructive pulmonary disease were the most important predictive factors for these complications. Patients with postoperative complications experienced a higher postoperative hospital stay.