A Novel Classification Proposal for Iatrogenic Arteriovenous Fistulas and Pseudoaneurysms After Transfemoral Cardiovascular Interventions-An Analysis of a Single-Center Database of 5941 Punctures.

Background: Pseudoaneurysms (psA) and arteriovenous fistulas (AVF) may complicate transfemoral cardiovascular interventions. This study aimed to determine their incidence, propose a morphological classification system, and evaluate associations with procedures and treatment options.

Methods: A prospective single-center study was conducted from 2012 to 2024 including 5941 femoral vessel cannulations in 4700 patients screened using Doppler ultrasound for post-intervention complications. PsA and AVF were categorized into morphological types, and their frequencies and associations with different medical interventions were analyzed.

Results: A total of 280 vascular complications (4.78%) were identified: 146 (2.5%) isolated psA, 109 (1.8%) isolated AVF, and 25 (0.4%) combined psA and AVF. A detailed analysis defined two morphological variants: Type I, without measurable communicating channel between the sac and the artery (psA), or the artery and the vein (AVF), and Type II, defined by its presence. A rare variant, Type III AVF, featured a sac-like dilation along the fistulous channel. AVF types were further subtyped as A (isolated AVF) or B (coexisting with psA). There was no significant difference in the occurrence of morphological Type I psA compared to Type II (p = 0.146), while Type I AVF was more frequent than Type II (p < 0.001). Electrophysiological interventions resulted in fewer psA (p < 0.001) and AVF (p = 0.001) than coronary interventions. There was no significant relationship between the morphological variants and procedure category (p = 0.08). Right-sided cannulations were associated with higher risks of psA (p < 0.001) and AVF (p = 0.034).

Conclusion: This study introduces a novel classification system for psA and AVF, supporting standardized reporting and treatment planning.