Incidence, Predictors, and Management of Femoral Vascular Complications Following Catheter Ablation for Atrial Fibrillation: A Systematic Duplex Ultrasound Study

Figures

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  Figure 1. Incidence and management of femoral vascular complications. The bar graph shows the number and percentage of patients experiencing various femoral vascular complications (hematomas, arteriovenous fistulas, and pseudoaneurysms) along with their management strategies. Dark blue bars represent patients managed through observation, while light gray bars indicate those managed with intervention. Hematomas occurred in 14 patients, with 13 (92.9%) managed by observation and one (7.1%) by intervention. Arteriovenous fistulas were observed in eight patients, with five (62.5%) managed by observation and three (37.5%) by intervention. Pseudoaneurysm occurred in four patients, all of whom (100%) were managed with intervention.

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  Figure 2. Monthly incidence of femoral vascular complications. This bar graph displays the distribution of femoral vascular complications (hematomas, arteriovenous fistulas, and pseudoaneurysms) by month. Each color represents a specific type of complication: dark blue for hematomas, light gray for arteriovenous fistulas, and black for pseudoaneurysms. Complications peaked in April, with a total of five cases (four hematomas and one arteriovenous fistula), which may reflect the initial learning curve of a new practitioner that started in March. As the new practitioner gains experience over the year, complication rates may decrease, until a new, inexperienced practitioner takes over each March, potentially leading to similar early peaks annually.

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  Figure 3. Follow-up of femoral vascular complications. The bar graph illustrates the resolution status of patients with different femoral vascular complications (hematomas, arteriovenous fistulas, and pseudoaneurysms). Dark blue bars indicate patients whose complications resolved, while light gray bars represent those without resolution. Among patients with hematomas, all 14 (100%) showed resolution. For arteriovenous fistulas, two patients (25%) achieved resolution, while six (75%) did not. In cases of pseudoaneurysm, all four patients (100%) experienced resolution.

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  Figure 4. Post-procedural and follow-up duplex ultrasonography (DUS) of an arteriovenous fistula from the right deep femoral artery to the right common femoral vein in a 60-year-old male patient after radiofrequency ablation for atrial fibrillation. The white arrow indicates the neck of the arteriovenous fistula in all images. (A) DUS obtained one day after the procedure. The right deep femoral artery is shown above the arrow, and the right common femoral vein below it. Doppler flow acceleration (the colored area indicated by the white arrow) was observed as blood flowed from the right deep femoral artery through the neck into the right common femoral vein. (B) Spectral Doppler image from one day post-procedure. The diameter of the neck (the colored area indicated by the white arrow) was measured as 1.0 mm, with a flow velocity of 333.2 cm/s. (C) Two-dimensional image at six months after the procedure. The size of the fistula neck (the white arrow) increased from 1.0 mm to 2.6 mm (diameter measured by white spot to spot). (D) Spectral Doppler image at six months post-procedure. A more arterialized waveform (the colored area indicated by the white arrow) was observed within the right common…

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  Figure 5. Post-procedural and follow-up duplex ultrasonography (DUS) of a pseudoaneurysm at the left common femoral artery in a 66-year-old female patient after redo-radiofrequency ablation for atrial fibrillation. (A) DUS one day after the procedure. The blue area in the bottom right corresponds to the body of the pseudoaneurysm, and the unnumbered cross corresponds to the major axis of the neck. A neck with a 1.4 mm orifice diameter (the distance between the yellow cross labeled 1 and the cross labeled 2) and a length of 16.9 mm (the distance between the two unnumbered yellow crosses) was observed between the left common femoral artery and the pseudoaneurysm on the Doppler image. (B) Spectral Doppler image one day after the procedure. “To-and-from” flow was observed with waveforms above and below the baseline in the pseudoaneurysm neck between the arterial vessel and the sac. (C) Two-dimensional image taken a day after the procedure. A low echogenicity pseudoaneurysm and its neck are present on the left of the cross-section of the left common femoral artery, though this was challenging to confirm without Doppler imaging. (D) Two-dimensional image one month after the procedure. Thrombotic…