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.