Infected Femoral Artery False Aneurysms

Etiology

A common etiology for the formation of infected femoral artery pseudoaneurysms, especially in urban settings, is intravenous drug use. Femoral venous injection is usually employed by experienced drug users who have exhausted other access sites. Inadvertent arterial injection is usually a distinct event that is often remembered. Such a misadventure may be referred to as a “miss,” “red blood,” “hot line,” or “hitting the pink.” The mean age of these patients is 34 to 37 years, and the mean duration of drug use is 16 years.

Infection at the sites of open and percutaneous arterial procedures is a less common cause. Infected anastomotic false aneurysms involving prosthetic grafts are fortunately uncommon, but they can have devastating consequences. Likewise, as the numbers of percutaneous access procedures have increased for the purpose of invasive arterial testing and monitoring, so have the associated complications. Iatrogenic trauma from percutaneous coronary and peripheral vascular interventions are an additional documented cause of infected false aneurysms. Although femoral artery closure devices can improve the patient’s comfort, increase interventional laboratory productivity, and decrease time to hemostasis in settings of periprocedural anticoagulation, their use has also been associated with the formation of femoral artery pseudoaneurysms. In a study of 450 patients who had undergone percutaneous closure of cardiac catheterization sites, two patients developed infected femoral artery pseudoaneurysms. Both were diabetic and had diagnostic studies with 6-Fr catheters with deployment of the Perclose device. It is hypothesized that the long braided suture acts as a pathway for skin flora to penetrate down to deeper tissue.