Pseudoaneurysm

Excerpt

An arterial pseudoaneurysm, otherwise known as a false aneurysm, is an uncommon but well-known condition that can occur at any arterial site after an arterial puncture, which results in a locally contained turbulent blood flow forming a hematoma with a neck that typically does not close spontaneously beyond a specific size. Pseudoaneurysms may also result following arterial injury due to trauma or infection. Unlike true aneurysms in which the blood vessel wall balloons, a pseudoaneurysm does not involve the vascular wall. Instead, blood leaks from the injury site and is contained by a wall developed with the products of the clotting cascade. Eventually, a wall forms from fibrin and platelet crosslinks that are ultimately weaker than those of a true aneurysm. The most commonly encountered pseudoaneurysms include cardiac, femoral, visceral, and aortic pseudoaneurysms. These pseudoaneurysms are separate disease entities that occur in many situations and require specific workup and treatment.

The most common clinical presentation of a pseudoaneurysm is a femoral pseudoaneurysm that develops following arterial access placement for endovascular procedures. Prompt recognition and treatment are required. Typically, most superficial pseudoaneurysms present as a painful, pulsatile mass with symptoms developing within 24 hours of arterial injury or insulting procedure. The recommended imaging studies for diagnosing a pseudoaneurysm depend on the location; however, angiography and duplex ultrasonography are most commonly utilized to evaluate the size, anatomy, and origin. The characteristics of the false aneurysm (eg, size, location, and complicated type) guide the treatment of choice, especially for femoral pseudoaneurysms.