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Case Report
Iatrogenic bilocular femoral artery pseudoaneurysm in a patient with end-stage renal disease undergoing regular hemodialysis: An unexpected occurrence after a common procedure and surgical cure
1 MS (General Surgery), DNB, M.Ch (Plastic Surgery), DNB, MNAMS, DAFPRS, FICS, Head of Department, Department of Plastic, Craniofacial and Microsurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 MD (Radiodiagnosis), Assistant Professor, Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
3 Resident Doctor, Department of Plastic, Craniofacial and Microsurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Address correspondence to:
Sarika Gangwar
Resident Doctor, Department of Plastic, Craniofacial and Microsurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh,
India
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Article ID: 101445Z01AG2024
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Agarwal A, Chakrabarti D, Gangwar S. Iatrogenic bilocular femoral artery pseudoaneurysm in a patient with end-stage renal disease undergoing regular hemodialysis: An unexpected occurrence after a common procedure and surgical cure. Int J Case Rep Images 2024;15(1):55–60.ABSTRACT
Introduction: Pseudoaneurysms of the femoral artery can develop as an uncommon complication following penetrating trauma or arterial catheterization for cardiovascular procedures or hemodialysis. It is commonly diagnosed with color duplex imaging and usually a single pseudoaneurysm is present.
Case Report: We present a 62-year-old woman with end-stage renal disease who developed a very rare bilocular pseudoaneurysm of the femoral artery caused by inadvertent puncture of the artery during elective hemodialysis which remained uneventful and undiagnosed until the pseudoaneurysm was itself punctured by the dialysis catheter iatrogenically and another large connecting pseudoaneurysm was formed above the initial one. Typical unilocular pseudoaneurysm presents as Yin-Yang sign on color duplex imaging but here bidirectional turbulent flow was seen as double Yin-Yang sign suggestive of bilocular pseudoaneurysm mimicking the shape of a snowman, hence Yin-Yang Snowman sign. The patient presented with signs and symptoms of rapid progression of the pseudoaneurysm resulting in femoral nerve compression with compromised skin viability. Therefore, surgical management was planned and the bilocular pseudoaneurysms were excised with repair of the femoral artery and then covered with vascularized rectus femoris muscle flap.
Conclusion: An arterial pseudoaneurysm should be included in the differential diagnosis for a groin mass after femoral catheterization or other vascular procedures. A non-invasive imaging approach using color flow duplex sonography can be used with confidence and safety. But in complicated cases or cases with impending complications, surgical exploration and excision remains the mainstay of treatment.
Keywords: Bilocular pseudoaneurysm, Femoral artery pseudoaneurysm, Groin mass, Snowman Yin-Yang sign
SUPPORTING INFORMATION
Author Contributions
Amit Agarwal - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Debalina Chakrabarti - Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sarika Gangwar - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Amit Agarwal et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
