A 68-year-old man develops a pulsatile groin mass with an audible bruit three days after transfemoral coronary angiography. Duplex ultrasound shows a 3 cm sac adjacent to the common femoral artery containing bidirectional swirling flow, connected to the artery by a narrow neck, with a 'to-and-fro' spectral waveform in the neck. He is haemodynamically stable. The most appropriate next step is:

• A Ultrasound-guided percutaneous thrombin injection into the sac ✓
• B Immediate open surgical repair of the femoral artery
• C Covered stent deployment across the neck of the sac
• D Reassurance and follow-up imaging only

Explanation

The findings are those of a post-catheterization femoral pseudoaneurysm, and ultrasound-guided thrombin injection is the accepted first-line treatment for uncomplicated cases because it obliterates the sac quickly without surgery. Surgery is reserved for infected, rapidly expanding or skin-threatening lesions, and a covered stent risks occluding a major femoral branch. Observation alone may be offered for very small asymptomatic sacs, but a symptomatic 3 cm pseudoaneurysm warrants active closure.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.