Manual compression repair of post-catheterization femoral pseudoaneurysms: An alternative to ultrasound guided compression repair?

Background: It is unknown, whether direct guidance by ultrasound is essential for the safety and efficacy of ultrasound-guided compression repair (UGCR) of pseudoaneurysms. We therefore tested, whether clinically guided manual compression repair (MCR) without continuous ultrasound control may represent an equally effective alternative. Methods: After ultrasound diagnosis of a pseudoaneurysm, direct manual compression was applied to the lesion until the characteristic clinical signs disappeared or for a maximum of 1 hour. Then a compression bandage was applied for 24 hours. If the pseudoaneurysm persisted, MCR was repeated up to a maximum of three times. Results: Of 96 consecutive patients with pseudoaneurysms, ten patients were referred to primary surgery; one patient refused any therapy. The remaining 85 patients (89%) were treated by MCR. MCR was successful in 74 patients (87%). Of these, 74% were cured at the first attempt, while 16% resp. 10% required 2 resp. 3 compression manoeuvers for definite cure. The success rate tended to be somewhat lower in patients on anticoagulants (78%) than in those on aspirin (91%) or those without any antithrombotic medication (89%) (p = 0.14). No major complications were observed. Of the 11 patients in whom MCR was unsuccessful, five patients underwent surgical repair; in four patients the pseudoaneurysms thrombosed spontaneously within 1-3 months and 2 pseudoaneurysms persist without complications. Conclusions: Our results with MCR are comparable to those published for UGCR. Since MCR requires less technical equipment and seems to be less painful for the patient, a prospective comparison of both methods appears warranted.