Multidisciplinary Journal Epistemology of the Sciences
Volume 3, Issue 1, 2026, January-March
DOI: https://doi.org/10.71112/t6avrg71
UNCOMMON VASCULAR COMPLICATION: PSEUDOANEURYSM OF THE
COMMON FEMORAL ARTERY FOLLOWING RECURRENT RIGHT INGUINAL
HERNIOPLASTY
COMPLICACIÓN VASCULAR INFRECUENTE: PSEUDOANEURISMA DE LA
ARTERIA FEMORAL COMÚN TRAS HERNIOPLASTIA INGUINAL DERECHA
RECURRENTE
Sergio Omar Ajpacajá García
Stephany Johana Maldonado
Estuardo Emmanuel Ruiz Gramajo
Caroll Andre García Salpor
Guatemala
DOI: https://doi.org/10.71112/t6avrg71
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Uncommon vascular complication: pseudoaneurysm of the common femoral
artery following recurrent right inguinal hernioplasty
Complicación vascular infrecuente: pseudoaneurisma de la arteria femoral
común tras hernioplastia inguinal derecha recurrente
Sergio Omar Ajpacajá García
grovermercadocondori@gmail.com
https://orcid.org/0009-0009-7032-3853
Radiology Department at Hospital Regional
de Occidente, Quetzaltenango
Guatemala
Stephany Johana Maldonado
stephanyjohana21@gmail.com
https://orcid.org/0009-0002-8492-8174
Radiology Department at Hospital Regional
de Occidente, Quetzaltenango
Guatemala
Estuardo Emmanuel Ruiz Gramajo
ruizgram.ee@gmail.com
https://orcid.org/0009-0001-1520-9726
Radiology Department at Hospital Regional
de Occidente, Quetzaltenango
Guatemala
Caroll Andre García Salpor
drchejo1@outlook.com
https://orcid.org/0009-0003-3806-3218
Universidad Mesoamericana,
Quetzaltenango
Guatemala
ABSTRACT
Femoral artery pseudoaneurysm is an uncommon but potentially severe vascular complication
that may occur following surgical procedures in the inguinal region. Its appearance is usually
associated with iatrogenic injury during dissection or reoperation. We present the case of a 58-
year-old male with a history of recurrent right inguinal hernioplasty, who developed a common
femoral artery pseudoaneurysm four months after surgery. Diagnosis was established by
Doppler ultrasound and CT angiography, confirming communication with the arterial lumen.
DOI: https://doi.org/10.71112/t6avrg71
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Direct surgical repair was performed with favorable postoperative evolution. Although rare, this
complication requires a high level of clinical and diagnostic suspicion to avoid severe
hemorrhagic consequences. Careful postoperative follow-up and accurate identification of
vascular structures are essential for prevention (Chowdhury et al., 2024; Gou et al., 2024).
Keywords: femoral pseudoaneurysm; inguinal hernioplasty; vascular complications; case
report; surgical iatrogenesis.
RESUMEN
El pseudoaneurisma de la arteria femoral es una complicación vascular poco común pero
potencialmente grave, que puede presentarse tras procedimientos quirúrgicos en la región
inguinal. Su aparición suele estar asociada con una lesión iatrogénica durante la disección o
una reoperación. Presentamos el caso de un hombre de 58 años con antecedentes de
hernioplastia inguinal derecha recurrente, quien desarrolló un pseudoaneurisma de la arteria
femoral común cuatro meses después de la cirugía. El diagnóstico se estableció mediante
ecografía Doppler y angiotomografía computarizada, que confirmaron la comunicación con el
lumen arterial. Se realizó reparación quirúrgica directa con evolución posoperatoria favorable.
Aunque infrecuente, esta complicación requiere un alto nivel de sospecha clínica y diagnóstica
para evitar consecuencias hemorrágicas graves. El seguimiento posoperatorio cuidadoso y la
identificación precisa de las estructuras vasculares son esenciales para su prevención
Palabras clave: pseudoaneurisma femoral; hernioplastia inguinal; complicaciones vasculares;
reporte de caso; iatrogenia quirúrgica.
Received: October 29, 2025 | Accepted: November 18, 2025 | Published: February 19, 2026
DOI: https://doi.org/10.71112/t6avrg71
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INTRODUCTION
Femoral artery pseudoaneurysm is a rare complication usually derived from invasive
procedures or surgeries in the inguinal region. It is characterized by the formation of an
extraluminal cavity communicating with the artery through a fibrous neck, resulting in a pulsatile
mass that may cause pain, hematoma, or compression of adjacent structures. Its occurrence
following hernioplasty is exceptional. The pathophysiology involves partial arterial wall injury
during surgical dissection or reoperation, especially in the presence of postoperative fibrosis.
Diagnosis is primarily established by color Doppler ultrasound, which demonstrates the
characteristic bidirectional “yin-yang” flow pattern. Multidetector CT angiography confirms
vascular communication and assists in therapeutic planning. (Mazurkiewicz et al., 2024).
METHODOLOGY
A retrospective, descriptive case report was conducted. Informed consent was
obtained from the patient for publication, ensuring anonymity and ethical compliance. Clinical
and imaging data were collected from the hospital record and analyzed for academic purposes.
Case presentation
A 58-year-old male from Totonicapán, Guatemala, with a history of recurrent right
inguinal hernioplasty performed four months earlier without previous symptoms, presented with
a progressive, painless inguinal mass. On physical examination, a pulsatile, expansive mass
with an audible bruit was identified.
Color Doppler ultrasound revealed an ovoid, isoechogenic image with double walls at
the level of the common femoral artery, showing bidirectional “yin-yang” flow, consistent with a
pseudoaneurysm. CT angiography confirmed a hyperdense lesion in the right inguinal region
communicating with the common femoral artery through a short neck of approximately 10 mm.
Due to lack of endovascular resources, conventional open surgery was performed. Dissection
DOI: https://doi.org/10.71112/t6avrg71
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and isolation of the pseudoaneurysm neck were followed by primary closure using 6-0
polypropylene suture. The postoperative course was satisfactory, with no complications or
recurrence on follow-up.
RESULTS
Although rare in the context of inguinal hernia repair, femoral artery pseudoaneurysm
represents a potentially serious vascular complication requiring early detection and prompt
management. Continuous clinical and imaging monitoring in patients with prior inguinal
surgeries, particularly reoperations, is crucial to prevent hemorrhagic or hemodynamic
complications. Early intervention, whether endovascular or open, ensures favorable outcomes
and minimizes risks.
Figura 1
Doppler Ultrasound Evaluation
Ultrasound with color Doppler evaluation showing the common femoral artery and adjacent to it
a saccular image with turbulent flow on color Doppler evaluation.
DOI: https://doi.org/10.71112/t6avrg71
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Figura 2
Cystic and heterogeneous mass with double wall
On ultrasound evaluation, a cystic, heterogeneous mass with a double wall is observed,
along with evidence of flow in a "polar" or "yin-yang" pattern on Doppler color imaging,
demonstrating a communication with the arterial lumen through a narrow neck.
Figura 3
Computed Tomography (Sagittal Section).
Sagittal section of single-phase tomography showing saccular defect originating from the
femoral artery.
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Figura 4
3D CT Angiography Reconstruction
3D reconstruction of CT angiography, showing filling defect in projection of the right femoral
artery.
The angiotomography shows a hyperdense mass with well-defined contours located in
the right inguinal region, maintaining communication with the common femoral artery through a
narrow neck. Upon reconstruction and contrast administration, there is partial loss of the lumen
and decreased vascular flow.
DOI: https://doi.org/10.71112/t6avrg71
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Figura 5
Intraoperative Finding
Intraoperative image showing common femoral artery with short neck pseudoaneurysm, as
shown in the background.
Figura 6
Final Surgical Repair
In the subsequent surgical CT scans, vascular skeletonization of the artery is observed,
along with dissection of the neck and primary closure of the defect with 5-0 Prolene.
DOI: https://doi.org/10.71112/t6avrg71
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DISCUSSION
Femoral pseudoaneurysm is a rare complication after inguinal surgeries, particularly
reoperation. The pathophysiology involves partial arterial wall disruption, allowing blood
extravasation contained by surrounding tissues, forming a cavity that communicates with the
arterial lumen. Persistent communication produces turbulent flow, preventing spontaneous
thrombosis and predisposing to rupture or neurovascular compression.
Reoperation is the main predisposing factor due to scar fibrosis distorting normal
anatomy and complicating vascular identification. The proximity of the common femoral artery to
the inguinal canal increases the risk of iatrogenic injury during deep dissection. Careful surgical
planning and meticulous dissection are essential preventive measures.
Doppler ultrasound is the first-line diagnostic tool due to its availability and sensitivity.
The “yin-yang” pattern is highly suggestive, helping differentiate pseudoaneurysms from
lymphoceles, seromas, or hematomas. Multidetector CT angiography further defines vascular
anatomy and guides therapeutic strategy.
Treatment depends on size, symptoms, and institutional resources. Options include
ultrasound-guided compression, thrombin injection, covered stent placement, or open repair. In
resource-limited settings, direct repair remains an effective approach with favorable outcomes.
Preventively, accurate vascular identification during hernioplasty is critical, especially in patients
with previous surgeries. (Gou et al., 2024).
CONCLUSIONS
Common femoral artery pseudoaneurysm is a rare but potentially severe vascular
complication following inguinal hernioplasty, particularly recurrent surgeries. Early diagnosis by
Doppler and CT angiography is key to preventing rupture or neurovascular compression. Direct
surgical repair is a safe, effective option where endovascular management is unavailable.
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Prevention relies on meticulous surgical techniques and careful postoperative surveillance.
(Alhewy, 2024).
Conflict of Interest Statement
There was no conflict of interest during the study, and it was not funded by any
organization.
Authorship Contribution Statement
Each author participated significantly in the conception, drafting, critical review, and
approval of the final manuscript, assuming responsibility for its content.
Artificial Intelligence Use Statement
The authors declare that Artificial Intelligence was used as support for this article, and
that this tool in no way replaced the intellectual task or process. They state and acknowledge
that this work is the result of their own intellectual effort and has not been published on any
artificial intelligence platform.
Acknowledgments
To the Western Regio’nal Hospital for supporting the Radiology department by providing
the necessary supplies and equipment for timely diagnosis of patients.
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