Delayed bleeding of femoral artery pseudoaneurysm: A rare complication of endovascular technique

Femoral artery pseudoaneurysm is the most common complication of femoral artery access. Since the 1990s, the most common access site for intracranial endovascular interventions has been the femoral artery. The incidence of pseudoaneurysm has been documented around 0.2%–0.5% following diagnostic procedures and up to 8% following therapeutic interventions. This study aimed to assess the rationale of observation of pseudoaneurysm and the risk therein. A 52-year-old female presented with a subarachnoid haemorrhage and basilar artery aneurysm. Endovascular coiling was done using the standard technique on the right femoral artery percutaneous access. On post-operative day, she had swelling in the right groin region with bluish discolouration of the skin. Later on, a necrotic skin patch developed. On palpation, tenderness and pulsatile mass were present. Colour Doppler and computed tomography angiography were suggestive of pseudoaneurysm. On post-operative day 24th, the patient developed sudden onset of bleeding and haematoma expansion. The patient was taken for emergency surgery with primary repair of pseudoaneurysm with bilobed skin graft for closer of skin defect. Pseudoaneurysms at the puncture site can increase during observation, can bleed and may require curative repair.