Can veins get pseudoaneurysms?

Femoral Vein Pseudoaneurysm: A Rare but Real Risk

While pseudoaneurysms are most commonly associated with arteries, they can, albeit rarely, occur in veins—particularly the femoral vein following percutaneous procedures. A recent case highlights this uncommon complication in a 68-year-old woman who underwent catheter ablation for atrial fibrillation at an outside facility. The procedure required vascular access through the femoral vein, a standard approach for such interventions.

What makes this case unusual is the development of a pseudoaneurysm in the vein rather than the more typical arterial site. Normally, pseudoaneurysms form when a tear in the vessel wall allows blood to collect in a contained pocket, sealed off by surrounding tissue rather than the vessel’s own layers. In arteries, this is a known risk after catheterization, but venous pseudoaneurysms are far less frequent and often underrecognized.

In this patient’s case, the complication arose due to unsuccessful manual compression after catheter removal. When pressure isn’t effectively applied or maintained, the venous puncture site may continue to leak, leading to hematoma formation and eventual pseudoaneurysm. Symptoms can include localized pain, swelling, or a pulsatile mass in the groin, though some cases remain silent until complications like thrombosis or rupture occur.

Diagnosis typically involves Doppler ultrasound, which can differentiate a venous pseudoaneurysm from other post-procedural swellings. Once identified, treatment ranges from ultrasound-guided compression repair and thrombin injection to surgical intervention in more complex cases.

While rare, this case serves as a reminder that even routine access sites carry risks. Careful post-procedural monitoring and proper compression techniques are essential—not just for arteries, but for veins too. As minimally invasive procedures become more widespread, recognizing atypical complications like venous pseudoaneurysms ensures timely and effective care.