Three weeks after transfemoral coronary angiography, a 62-year-old woman notices a pulsatile groin lump with a bruit. Duplex shows a 2 cm collection communicating with the common femoral artery displaying yin-yang colour flow and a to-and-fro spectral pattern. She is haemodynamically stable and not anticoagulated. What is the most appropriate initial treatment?

• A Covered stent graft across the common femoral artery
• B Immediate open surgical exploration and arterial repair
• C Prolonged manual compression followed by bed rest alone
• D Ultrasound-guided percutaneous thrombin injection into the sac ✓

Explanation

The duplex findings of yin-yang flow and a to-and-fro neck waveform are diagnostic of a false (pseudo) aneurysm following femoral puncture. For an uncomplicated small pseudoaneurysm, ultrasound-guided thrombin injection has become first-line therapy because it is quick, well tolerated and highly successful. Open repair is reserved for rapidly expanding lesions, infection, skin necrosis or failure of percutaneous methods, and prolonged compression alone has a lower success rate and considerable discomfort.

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.