Vascular complications occur in approximately 1 to 3 percent of diagnostic coronary angiograms. Those complications include perforation, aneurysm and pseudoaneurysm. A pseudoaneurysm is a disruption of one or two of the three layers of a blood vessel leading to a hematoma (collection of blood). (From the interior to the exterior, the three layers are the intima, the media, and the adventitia.) The blood still flowing through the artery is still in contact with the pseudoaneurysm, thereby exerting pressure on the wall of the pseudoaneurysm. The natural history of a pseudoaneurysm of any significant size is enlargement and potential vessel rupture, bleed, and death. Therefore, repair is necessary. Repair may be either surgical or noninvasive (with compression and, possibly, thrombin injection).
Femoral artery pseudoaneurysm as a complication following femoral artery puncture has been reported .2% to .5% of the time. In fact, although uncommon, the most likely cause of femoral artery pseudoaneurysm is catheter insertion. Pseudoaneurysms occur more frequently in older females or patients treated with anticoagulation agents such as heparin.
The occurrence of a pseudoaneurysm, however, does not necessarily indicate that there was a deviation from the standard of care or some operator-related error that did not rise to a deviation.
Vascular complications during coronary angiograms medical expert witness specialties include interventional cardiology, vascular surgery, and radiology.