Behavior-driven management of femoral artery pseudoaneurysms: two contrasting case reports and literature review
Imane Boulahroud, Bakkali Tarik, Ayoub Bounssir, Halaouate Imane, Samir Elkheloufi, Brahim LekehalIntroduction and importance:
Femoral artery pseudoaneurysms (FAPs) remain a frequent complication of percutaneous catheterization. Conventional algorithms based solely on lesion diameter may overlook clinical instability.
Case presentation:
We report two contrasting cases: a 6-mm FAP in a patient on dual antiplatelet therapy, complicated by hemoglobin drop, infection, and Angio-Seal failure requiring staged reconstruction, and a 27-mm FAP in an anticoagulated patient successfully treated with early surgical repair and uneventful follow-up.
Clinical discussion:
These cases demonstrate that dynamic lesion characteristics such as duplex flow patterns, skin integrity, antithrombotic burden, and closure device performance provide superior guidance for therapeutic decision-making compared with size thresholds alone.
Conclusion:
A behavior-driven framework may allow earlier recognition of high-risk lesions and guide timely intervention. Prospective multicenter validation is warranted.