Signs and Symptoms of Pseudoaneurysm
The most common signs of a pseudoaneurysm include a pulsatile mass, palpable thrill, and an audible to-and-fro murmur. 1
Clinical Presentation
Common Signs
- Pulsatile mass at the site of arterial injury 1, 2
- Audible to-and-fro murmur on auscultation 1, 3
- Palpable thrill over the affected area 1, 4
- Variable localized inflammatory response, ranging from minimal to significant 5
Variable Presentations
- Painful erythematous swelling, particularly in the groin area following vascular procedures 5
- Draining sinus tract, which is a highly suggestive sign of underlying vascular graft infection with pseudoaneurysm 5
- Sudden onset of bleeding or ischemia in approximately 50% of anastomotic site pseudoaneurysms, which can be life- or limb-threatening 5
- Thrombosis of the affected vessel with distal ischemia 5, 6
Diagnostic Challenges
- Physical examination alone misses more than 60% of pseudoaneurysms, making imaging essential 5, 7
- Pseudoaneurysms can be easily confused with hematomas or abscesses on clinical examination 7
- The presentation varies depending on timing - early pseudoaneurysms (<2 months post-procedure) often present with systemic signs including fever and leukocytosis, while late pseudoaneurysms (>2 months) typically have more indolent presentations 5
Complications to Watch For
- Rupture into surrounding tissues or retroperitoneal space 5, 6
- Venous thrombosis due to compression of adjacent veins 5, 3
- Painful neuropathy from compression of nearby nerves 5
- Distal embolization causing ischemia 5, 2
- Skin erosion in advanced cases 5
- Hemorrhage, which can be life-threatening 5, 3
Location-Specific Signs
- Femoral pseudoaneurysms (most common): groin swelling, pain, and bruising following catheterization 5, 1
- Thoracic aortic pseudoaneurysms: may present with signs similar to coarctation (arm BP higher than leg BP, delay between radial versus femoral artery pulsation) 5
- Facial artery pseudoaneurysms: visible or palpable pulsatile mass in the face 7
- Brachial artery pseudoaneurysms: pulsatile mass in the antecubital fossa, often after hemodialysis access attempts 3
Diagnostic Confirmation
- Duplex ultrasound is the diagnostic modality of choice, showing the pseudoaneurysm, communication with the parent artery, and characteristic "to-and-fro" flow pattern 7, 1, 4
- CT angiography or MR angiography may be needed for deeper or more complex pseudoaneurysms 6
Risk Factors for Development
- Longer procedures, large-bore catheters, and systemic anticoagulation increase the risk of iatrogenic pseudoaneurysms 1
- Trauma, including blunt trauma and penetrating injuries 5
- Vascular graft infections 5
- Faulty lower site of arterial puncture during procedures 1
Remember that while small pseudoaneurysms (<2.0 cm) often resolve spontaneously, larger ones or those with complications require prompt intervention to prevent morbidity and mortality 5, 7.