Fat Embolisation in Managing an Iatrogenic Expanding Femoral Artery Pseudoaneurysm

Abstract

Femoral artery pseudoaneurysm (FAP) is a known complication of femoral artery access. We report a novel case of rapid FAP expansion treated using subcutaneous fat embolisation. A 61-year-old woman became unwell following removal of her right femoral sheath used for a percutaneous coronary intervention. Examination revealed a large femoral haematoma. Bedside ultrasound confirmed a FAP with active expansion. A decision was made to perform a peripheral intervention to manage the pseudoaneurysm. As initial attempts at prolonged balloon inflation failed, subcutaneous fat embolisation was performed as a last attempt in sealing the pseudoaneurysm neck, which was successful. Common risk factors for femoral artery pseudoaneurysm include increasing age, obesity, being a woman, hypertension and a low femoral puncture site and these were all present in this patient. Haemodynamically unstable patients warrant surgical intervention although endovascular interventions have also been successfully reported in the literature. Our case report highlights how subcutaneous fat remains a viable option if embolisation is attempted in a resource-limited setting.