Common Femoral Vein Pseudoaneurysm After Atrial Fibrillation Ablation.

BACKGROUND: Venous pseudoaneurysms are rare complications of vascular access and are frequently misdiagnosed due to their nonspecific clinical presentation. CASE SUMMARY: A 76-year-old man presented with painful left lower extremity swelling and ecchymosis following atrial fibrillation ablation. Duplex ultrasonography revealed a left common femoral vein pseudoaneurysm. Ultrasound-guided thrombin injection was successfully performed. Follow-up imaging demonstrated complete thrombosis of the pseudoaneurysm. DISCUSSION: Common femoral vein pseudoaneurysm is a rare but clinically important complication of femoral venous access that may mimic deep vein thrombosis or soft tissue pathology, leading to delayed diagnosis. Duplex ultrasonography is essential for accurate identification. Unlike arterial pseudoaneurysms, venous pseudoaneurysms of the deep system carry substantial risk of venous thrombosis and pulmonary embolism. This case highlights the importance of maintaining a high index of suspicion following interventional procedures, the diagnostic value of duplex imaging, and illustrates the complexity of management decisions in the absence of established treatment guidelines.