Management of Profunda Femoris Pseudoaneurysm Following Neglected Intertrochanteric Fracture
Diagnostic Approach
- The American College of Cardiology recommends obtaining duplex ultrasound imaging immediately when pseudoaneurysm is suspected, as physical examination alone misses more than 60% of cases 2, 3
Treatment Algorithm
- The American Heart Association recommends that all symptomatic femoral artery pseudoaneurysms require repair regardless of size, including expanding or painful thigh mass, active bleeding or skin erosion, compressive symptoms, and unexplained anemia requiring transfusions 1, 2, 4
- Endovascular coil embolization is the preferred initial intervention for profunda femoris pseudoaneurysms, particularly in poor surgical candidates or when definitive orthopedic surgery is planned, with thrombin injection achieving a 93% success rate for catheter-related femoral pseudoaneurysms 5
- Open surgical repair is necessary when endovascular treatment fails or is not feasible anatomically, infected pseudoaneurysm is present, rupture into retroperitoneal space or expanding rupture into soft tissue occurs, or definitive orthopedic reconstruction is required 1, 2, 4
Critical Preventive Considerations
- Deep femoral artery pseudoaneurysms have higher rupture rates (33%) compared to other lower extremity pseudoaneurysms, emphasizing the need for prompt diagnosis and treatment 6, 1