A Case of High-Level Femoral Artery Bifurcation Contributing to Puncture-Site Pseudoaneurysm Following Neuroendovascular Intervention

Abstract

We report a case of high-level femoral artery bifurcation resulting in puncture-site pseudoaneurysm following neuroendovascular intervention. An 80-year-old man with symptomatic right intracranial carotid artery stenosis underwent successful percutaneous angioplasty by transfemoral approach. Postoperative femoral arteriography showed the level of the femoral artery bifurcation to be at the center of the femoral head and that the superficial femoral artery was punctured. The access site was treated with a vascular closure device and manual compression. Two days post-procedure, ultrasound examination showed a femoral pseudoaneurysm of 26-mm diameter at the puncture site. Six days post-procedure, the femoral artery was surgically reconstructed after failure of echo-guided compression. High femoral artery bifurcation is reported to be a rare and high-risk factor for pseudoaneurysms. The ideal puncture site is the main trunk of the femoral artery. During preprocedural fluoroscopy, determination of the puncture level, which should be between the superior border and center of the femoral head, could be essential in avoiding injury to other arteries. Moreover, confirmation of the punctured artery with postprocedural femoral arteriography may help in predicting the occurrence of pseudoaneurysms. Because the parallel course of the superficial and deep femoral arteries at the level of femoral head makes them difficult to differentiate through palpation, accurate compression under ultrasound guidance may avoid enlargement or bleeding of a pseudoaneurysm.