Life-Threatening Rupture of a False Aneurysm after Femoral Arterial Catheterization: Unexpected Delay after a Common Procedure

We report the case of a 79-year-old patient who presented with a femoral iatrogenic pseudoaneurysm of delayed and unusual onset with immediately life-threatening massive bleeding. Ultrasound is the method of choice for the diagnosis of pseudo aneurysm. If there is not spontaneous closure, ultrasound-guided compression repair, minimally invasive percutaneous treatments, and surgical repair are the three therapeutic options. 1. Summary A 79-year-old female patient was admitted to the intensive care unit for acute respiratory failure on day 1. Pertinent medical history included chronic obstructive pulmonary disease requiring long-term oxygen and corticosteroid therapies, atrial fibrillation, and pacemaker insertion. Her multiple medications included anticoagulation with fluindione, amiodarone, furosemide, rabeprazole, prednisolone, terbutaline, budesonide, and salbutamol. The patient deteriorated, was intubated, and mechanically ventilated for 2 days. She developed pneumonia with secondary septic shock, managed with norepinephrine for 48 hours and antibiotic therapies (piperacillin tazobactam and amikacin), as well as heart failure with required inotropic support for 72 hours. Continuous cardiac output using pulse contour analysis was measured by the PiCCO plus (PULSION Medical Systems, Munich, Germany). An arterial pressure line was inserted, using the Seldinger technique, into the right femoral artery (5？F, 20？cm long thermistor-tipped arterial catheter PV2015？L20-A; Pulsion Medical Systems, Munich, Germany) and connected to the cardiac output monitor for 5 days. The catheter removal was followed by manual compression for 15 minutes and bed rest. The patient was discharged in stable condition on day 5, from the ICU to the cardiology unit. On day 17, the patient experienced severe sharp pain in her right groin. Physical examination revealed hypotension (70/50？mmHg) and a voluminous mass in the right groin. The patient was transferred to the intensive care unit. On admission to intensive care unit, the mass in the right groin was indurate, pulsatile, and growing, without sign of neither nerve compression nor ischemia. Blood sample analysis was the following: haemoglobin 5.4？g/L, platelets 103 × 109/L, prothrombin time (PT) 21.6 seconds, INR 2, activated partial thromboplastin time (aPTT) 1.57 second, fibrinogen 4.2？g/L, pH 7.26, partial pressure of oxygen 164？mmHg, partial pressure of carbon dioxide 39？mmHg, HCO3 17.7？mmol/L, and lactates 1.9？mmol/L. Hemodynamic instability and a fall in haemoglobin indicated massive haemorrhagic shock of the right femoral