Infected Pseudoaneurysm with Necrotising Fasciitis Following Femoral Artery Catheterisation

Femoral pseudoaneurysm is the most common complication of femoral artery catheterisation usually diagnosed by colour doppler ultrasound. Ultrasound-guided compression has replaced surgery to be the mainstay of therapy due to its high success rate and low complications. The present case is about a 63-year-old female, who presented with pain and swelling in the right groin. She had undergone coronary angioplasty two weeks back. She developed fever, chills, wound induration and necrosis at the puncture site. A laboratory study revealed leucocytosis, elevated Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP). Ultrasound doppler showed a 4×2.8×2.7 cm pseudoaneurysm of the right superficial femoral artery with a to-and-fro flow pattern. Computed Tomography (CT) angiogram showed a large narrow neck pseudoaneurysm arising from the anterior wall of the proximal superficial femoral artery just distal to its origin. The right superficial femoral angiogram showed a pseudoaneurysm draining into a large cavity. She underwent an ultrasound-guided thrombin injection of the pseudoaneurysm. A thrombus was formed in the superficial femoral artery after thrombin injection and thrombosuction was done. The necrotic tissue was excised and skin grafting was done after the wound healed.