1. A.G. Vascular Surgery Service Morbidity and Mortality Conference 11/3/2010

2. Background 61M s/p right fem-pop bypass / femoral endarterectomy Stenosis suspected on follow-up duplex, not confirmed on MRA Present for angiography PMH: CAD s/p MI, hyperlipidemia, hypertension, bipolar disorder Meds: ASA, plavix (held 7 days prior to angio

3. Procedure Right lower extremity arterial angio Access via left femoral artery under U/S 4 Fr sheath, no intervention Pressure held for 12 minutes after removal Pt flat for 6 hours Call from PACU expanding hematoma Pressure held 15 minutes, stable Admit for observation Duplex in AM showed left pseudoaneurysm Tx: Direct thrombin injection under U/S

4. Complication Error in technique Grade IIIa complication requiring intervention not under general anesthesia

5. Iatrogenic Femoral Artery Pseudoaneurysm 0.2% in diagnostic, 8% interventional procedures