Hybrid Repair of a Giant Postcatheterization Femoral Pseudoaneurysm Using Dual Long-Balloon Occlusion: A Case Report

Femoral artery pseudoaneurysm is a well-recognized complication of arterial catheterization. While ultrasound-guided thrombin injection and endovascular interventions are increasingly employed, open surgical repair remains mandatory for large, symptomatic, or complicated lesions. However, obtaining surgical vascular control can be extremely challenging in giant pseudoaneurysms that extend beyond the inguinal ligament and distort the femoral bifurcation anatomy. A 60-year-old woman on maintenance hemodialysis presented with severe pain and tense swelling in her right groin two months after undergoing cardiac catheterization via a right femoral approach. Computed tomography revealed a giant pseudoaneurysm with a maximum diameter of 8 cm, extending proximally above the inguinal ligament and distally into the upper thigh. The pseudoaneurysm neck originated near the bifurcation of the superficial femoral artery (SFA) and profunda femoris artery (PFA). Due to signs of impending rupture, including excruciating pain and overlying skin discoloration, emergency surgery was indicated. Because conventional surgical exposure for proximal and distal clamping was deemed hazardous due to the massive size and anatomical complexity of the lesion, a hybrid approach was adopted. Through a contralateral femoral approach, dual-balloon occlusion of both the SFA and PFA was performed to control systemic inflow and retrograde collateral backflow. Immediate surgical incision of the pseudoaneurysm sac under a completely bloodless operative field allowed for precise identification and direct suture closure of the neck. The patient's postoperative course was uneventful, and she was discharged on postoperative day 3. At the two-month outpatient follow-up, she remained asymptomatic with no clinical evidence of recurrent pseudoaneurysm or wound-related complications. Dual-balloon occlusion combined with open surgical repair represents a highly effective and safe hybrid strategy for treating giant femoral pseudoaneurysms when conventional vascular control is technically demanding or unsafe. This technique provides excellent visualization, facilitates precise neck closure, and minimizes surgical invasiveness in anatomically complex lesions.