Iatrogenic Deep Femoral Artery Pseudoaneurysm Causing Quadriceps Paralysis: An Indication for Open Surgery in an Endovascular Era

Contemporary management of iatrogenic pseudoaneurysms is mostly performed using non-surgical techniques. Herein, we present a rare case of deep femoral artery (DFA) pseudoaneurysm with compression neuropathy, which required open repair. A 67-year-old female patient presented with increasing pain in the right groin, sensory neuropathy of the anteromedial thigh and upper leg, and quadriceps paralysis 4 days after coronary angiography via femoral puncture. Computed tomography angiography revealed a pseudoaneurysm of the DFA. The disabling compressive neuropathy warranted urgent open decompression rather than thrombin injection or endovascular therapy. Timely open evacuation of the hematoma, release of compression on the femoral nerve, and postoperative physiotherapy resulted in complete recovery of quadriceps power. The patient was pain free within 12 weeks and able to ambulate independently. This case report highlights the role of prompt open surgery for pseudoaneurysms with compression neuropathy.