How to evaluate and to avoid vascular complications at the puncture site

  • Franz Fobbe
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 173)


The technique for transfemoral vascular puncture described by Seldinger in 1953 [1] is basically still used today. The procedure can also be used for puncturing the axillary artery or brachial artery. Although it is regarded as the method of choice, the Seldinger technique can lead to various complications at the puncture site. This chapter deals with possible causes and the diagnostic evaluation of such complications and their therapeutic management.


Femoral Artery Brachial Artery Vascular Complication Arteriovenous Fistula Puncture Site 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Seldinger SI. Catheter replacement of the needle in percutaneous arteriography. A new technique. Acta Radiol 1953; 39: 368–76.CrossRefGoogle Scholar
  2. 2.
    Cumberland DC. Percutaneous angioplasty. In: Ansel G, Wilkins RA, editors. Complications in diagnostic radiology. Oxford: Blackwell, 1987.Google Scholar
  3. 3.
    Hessel SJ, Adams DF, Abrams HL. Complications of angiography. Radiology 1981; 138: 273–81.PubMedGoogle Scholar
  4. 4.
    Wilkins RA, Garvey CJ. Diagnostic arteriography. In: Ansel G, Wilkins RA, editors. Complications in diagnostic radiology. Oxford: Blackwell, 1987.Google Scholar
  5. 5.
    Kresowik TF, Khoury MD, Miller BV et al. A prospective study of the incidence and natural history of femoral vascular complications after percutaneous transluminal coronary angioplasty. J Vasc Surg 1991; 13: 328–36.PubMedCrossRefGoogle Scholar
  6. 6.
    Skillman JJ, Kim D, Bairn DS. Vascular complications of percutaneous femoral cardiac interventions. Arch Surg 1988; 123: 1207–12.PubMedGoogle Scholar
  7. 7.
    Babu SC, Piccorelli GO, Shah PM et al. Incidence and result of arterial complications among 16350 patients undergoing cardiac catheterization. J Vasc Surg 1989; 10: 113–6.PubMedGoogle Scholar
  8. 8.
    Davis K, Kennedy JW, Kemp HG et al. Complications of coronary arteriography from the collaborative study of coronary artery surgery (CASS). Circulation 1979; 59: 1105–12.PubMedGoogle Scholar
  9. 9.
    McCollum CH, Mavor E. Brachial artery injury after cardiac catheterization. J Vasc Surg 1986; 4: 355–9.PubMedGoogle Scholar
  10. 10.
    AbuRahma AF, Robinson PA, Boland JP. Safety of arteriography by direct puncture of a vascular prosthesis. Am J Surg 1992; 164: 233–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Mohr LL, Smith DC, Schaner GJ. Catheterization of synthetic vascular grafts. J Vasc Surg 1986; 3: 854–6.PubMedGoogle Scholar
  12. 12.
    Smith, DC. Catherization of prosthetic vascular grafts. Acceptable technique. Am J Radiol 1984; 143: 1117–1118.Google Scholar
  13. 13.
    Almgren B, Karacagil S, Nybacka O. Arteriovenous fistula following transfemoral angio-graphy. Aust N Z J Surg 1990; 60: 549–50.PubMedCrossRefGoogle Scholar
  14. 14.
    Altin RS, Flicker S, Naidech HJ. Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: Association with low femoral punctures. Am J Radiol 1989; 152: 629–31.Google Scholar
  15. 15.
    Grier D, Hartnell G. Percutaneous femoral artery puncture: Practice and anatomy. Br J Radiol 1990; 63: 602–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Rapoport S, Sniderman KW, Morse SS et al. Pseudoaneurysm: A complication of faulty technique in femoral arterial puncture. Radiology 1985; 154: 529–30.PubMedGoogle Scholar
  17. 17.
    Spijkerboer AM, Scholten FG, Mali PTM, van Schaik JPJ. Antegrade puncture of the femoral artery: Morphologic study. Radiology 1990; 176: 57–60.PubMedGoogle Scholar
  18. 18.
    Frood LR, Smith DC, Pappas JM et al. Use of angiographic needles with or without stylets: Pathologic assessment of vessel walls after puncture. J Vasc Intervent Radiol 1991; 2: 269–72.CrossRefGoogle Scholar
  19. 19.
    Haygood TM, Spar J, Orrison WW, Eldevik OP. A simple and effective postangiographic femoral artery pressure dressing. Cardiovasc Intervent Radiol 1993; 16: 262–3.PubMedCrossRefGoogle Scholar
  20. 20.
    Wolf KJ, Fobbe F. Color duplex sonography. Stuttgart, New York: Thieme, 1995.Google Scholar
  21. 21.
    Colapinto RF, Harty PW. Femoral artery compression device for outpatient angiography. Radiology 1988; 166: 890–1.PubMedGoogle Scholar
  22. 22.
    Foshager MC, Finlay DE, Longley DG, Letourneau JG. Duplex and color Doppler sonography of complications after percutaneous interventional procedures. Radio Graphics 1994; 14: 239–53.Google Scholar
  23. 23.
    Mitchell DG, Needleman L, Bezzi M et al. Femoral artery pseudoan urysm: Diagnosis with conventional duplex and color Doppler US. Radiology 1987; 165: 687–90.PubMedGoogle Scholar
  24. 24.
    Igidbashian VN, Mitchell DG, Middleton WD et al. Iatrogenic femoral arteriovenous fistula: Diagnosis with color Doppler imaging. Radiology 1989; 170: 749–52.PubMedGoogle Scholar
  25. 25.
    Johns JP, Pupa LE, Bailey SR. Spontaneous thrombosis of iatrogenic femoral artery pseudo-aneuryms: Documentation with color Doppler and two dimensional ultrasonography. J Vasc Surg 1991; 14: 24–2.PubMedCrossRefGoogle Scholar
  26. 26.
    Paulson EK, Hertzberg BS, Paine SS, Caroli BA. Femoral artery pseudoaneuryms: Value of color Doppler sonography in predicting which ones will thrombose without treatment. Am J Radiol 1992; 159: 1077–81.Google Scholar
  27. 27.
    Roberts SR, Main D, Pinkerton J. Surgical therapy of femoral artery pseudoaneurysm after angiography. Am J Surg 1987; 154: 676–80.PubMedCrossRefGoogle Scholar
  28. 28.
    Agrawal SK, Pinheiro L, Roubin GS et al. Nonsurgical closure of femoral pseudoaneurysms complicating cardiac catheterization and percutaneous transluminal coronary angiography. JACC 1992; 20: 610–5.PubMedGoogle Scholar
  29. 29.
    Feld R, Patton GM, Carabasi RA et al. Treatment of iatrogenic femoral artery injuries with ultrasound-guided compression. J Vasc Surg 1992; 16: 832–40.PubMedCrossRefGoogle Scholar
  30. 30.
    Fellmeth BD, Roberts AC, Bookstein JJ et al. Postangiographic femoral artery injuries: Nonsurgical repair with US-guided compression. Radiology 1991; 178: 671–5.PubMedGoogle Scholar
  31. 31.
    Sorrell KA, Feinberg RL, Wheeler JR et al. Color-flow duplex-directed manual occlusion of femoral false aneurysms. J Vasc Surg 1993; 17: 571–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Hilborn M, Downey D. Deep venous thrombosis complicating sonographically guided compression repair of a pseudoaneurysma of the common femoral artery. Am J Radiol 1993; 161: 1334–5.Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Franz Fobbe
    • 1
  1. 1.Department of Diagnostic RadiologyFreie Universität Berlin, Universitätsklinikum Benjamin FranklinBerlin 45Germany

Personalised recommendations