The Importance of Ultrasound-Guided Manual Compression in Iatrogenic Pseudoaneurysm Treatment: The Sooner the Better

Objective: Although ultrasound-guided manual compression is a safe and cost-effective method in the treatment of pseudoaneurysm, there are many factors affecting the success of the procedure. This study aimed to determine the factors affecting the success of ultrasound-guided manual compression. Methods: The records of patients who developed iatrogenic femoral artery pseudoaneurysm in the cardiology department between 2017 and 2020 were retrospectively analyzed. Data regarding patients, procedural and aneurysm-related factors were evaluated by univariate and multivariate logistic regression analysis. Results: Seventy-five patients who underwent ultrasound-guided manual compression were included in our study. In study population, the rate of successful ultrasound-guided manual compression is 72%. As a result of the univariate analysis, hypertension, diabetes mellitus, sheath size, the length of aneurysm sac, the width of aneurysm sac, compression duration, aneurysm detection time> 24 hours parameters were found to be significant predictors for failed ultrasound-guided manual compression. In the multivariate analysis, it was found that the independent predictors associated with failed ultrasound-guided manual compression were the aneurysm detection time longer than 24 hours and the length of aneurysm sac (odds ratio: 5.908; 95% CI 1.136-30.720; P=.035 and odds ratio: 1.042; 95% CI 1.008-1.100; P=.045). In receiver operating characteristic (ROC) curve analysis, the length of the pseudoaneurysm sac of 34 mm and above had 90% sensitivity and 57% specificity for failed ultrasoundguided manual compression. Conclusions: Ultrasound-guided manual compression is an effective method in the treatment of pseudoaneurysm. However, early detection and size of pseudoaneurysm are important for the success of this treatment. Checking the operation site within the first 24 hours after catheterization is important for early diagnosis and treatment of possible complications. In addition, it should be considered that treatment success is low in length of pseudoaneurysm sacs longer than 34 mm.