StructuralPseudoaneurysm after transpedal arterial access for evaluation and treatment of peripheral arterial disease

- Pedal artery pseudoaneurysm (PSA) related to access complicating transpedal access (TPA) catheterization is reported.
- PSA associated with TPA is extremely rare and seems to occur exclusively after posterior tibial artery access.
- It is easily treatable by ultrasound guided thrombin injection without complications.

BackgroundThere has been an increasing use of transpedal arterial access (TPA) for evaluation and treatment of peripheral arterial disease (PAD) over a transfemoral approach (TFA). TPA, it is expected to be associated with better patient comfort, less recovery time and possibly less access site complications compared to standard TFA. Access site complications and pseudoaneurysm (PSA) associated with the TPA have not been previously reported.ObjectiveHere we report a series of pedal artery PSA related to access site complicating TPA catheterization.MethodsWe studied 1460 patients with symptomatic PAD who underwent 2236 peripheral diagnostic and/or interventional procedures between 06/2014 and 01/2016 via TPA. Hemostasis was achieved using patent hemostasis technique by a radial artery compression device for 2 h. PSA related to the access site were suspected clinically and confirmed with arterial duplex ultrasound.ResultsThe incidence of PSA related to any access site was 0.002%. In this series all PSA occurred only in the posterior tibial artery, after an interventional procedure. All patients were treated successfully with thrombin injection with no residual complications.ConclusionsPSA associated with TPA is extremely rare and seems to occur exclusively after posterior tibial artery access. It is easily treatable by thrombin injection.