From the Guidelines
Pseudoaneurysm repair is always indicated, regardless of size or position, to prevent progression and rupture, as stated in the most recent guidelines 1.
Diagnosis and Treatment
A pseudoaneurysm is a collection of blood that forms between the two outer layers of an artery, resulting from damage to the arterial wall without complete rupture. Unlike true aneurysms, pseudoaneurysms don't involve all three layers of the arterial wall. They typically occur after trauma, surgery, infection, or invasive procedures like catheterization. Common locations include the femoral artery (after cardiac catheterization), carotid arteries, and visceral arteries. Symptoms depend on location but may include pain, swelling, a pulsatile mass, or bleeding. Diagnosis usually involves ultrasound with Doppler, CT angiography, or MR angiography, which show the characteristic "to-and-fro" blood flow pattern.
Treatment Options
Treatment options for pseudoaneurysms include:
- Open surgery
- Endovascular treatment (occluders, stent grafts, or coils) The choice of treatment depends on anatomical features, clinical presentation, and the patient’s comorbidities, and should be decided by a multidisciplinary team in specialized centers 1.
Size and Position Considerations
While some guidelines suggest that pseudoaneurysms smaller than 2.0 cm in diameter can be reevaluated by ultrasound 1 month after the original injury 1, the most recent guidelines recommend that pseudoaneurysm repair is always indicated, regardless of size or position, to prevent progression and rupture 1.
Key Considerations
Key considerations in the management of pseudoaneurysms include:
- Preventing progression and rupture
- Choosing the appropriate treatment based on anatomical features, clinical presentation, and patient comorbidities
- Involving a multidisciplinary team in specialized centers in the decision-making process 1.
From the Research
Definition and Causes of Pseudoaneurysm
- Pseudoaneurysm is a condition that may arise from any artery in the human body, most commonly found to involve the femoral artery after angiography 2.
- It can be caused by iatrogenic factors, such as catheterization of the femoral artery, and is associated with significant morbidity 3.
Treatment Options for Pseudoaneurysm
- Ultrasound-guided thrombin injection (UGTI) is a fairly easy and effective treatment option for pseudoaneurysms 2.
- Other endovascular approaches, such as stent graft repair and coil embolization, are also available 2.
- Surgical treatment is usually reserved for cases where nonsurgical methods are not effective or feasible 4.
Efficacy and Safety of Ultrasound-Guided Thrombin Injection
- UGTI has been shown to be a safe and effective method for treating iatrogenic pseudoaneurysms, with primary success rates ranging from 85% to 100% 5, 3, 4, 6.
- The procedure is minimally painful and can be performed on an outpatient basis 5.
- Predictors of primary failure with UGTI include age, neck diameter, and anteroposterior diameter of the pseudoaneurysm 6.
Comparison of Treatment Options
- UGTI is considered a preferable method of treatment for iatrogenic pseudoaneurysms after invasive cardiovascular procedures, due to its high success rate and minimal complications 4.
- Watchful waiting, ultrasound-guided compression, and surgical treatment are other options, but UGTI is often the most effective and safe choice 4.