Vascular: Peripheral Pseudoaneurysm

Pseudoaneurysm

Basics

  • Definition: Blood Collection Between the Tunica Media and Adventitia
  • False Aneurysm (Not Enclosed by All 3 Layers)
  • Cause:
    • Iatrogenic (Peripheral Catheterization) – Most Common Cause
    • Infection
    • Trauma
  • Most Common Site: Femoral Artery

Presentation

  • Painful Pulsating Mass
  • Associated Hematoma
  • Bruit
  • Rupture

Diagnosis

  • Duplex US – Preferred

Treatment

  • Asymptomatic & < 2-3 cm: Observation & Repeat US in 4 Weeks
  • Symptomatic or > 2-3 cm: US-Guided Thrombin Injection
    • Consider US-Guided Compression if Thrombin Contraindicated
      • Compress for 10-20 Minutes to Induce Thrombosis
      • Avoid Excessive Pressure – Causes Thrombosis within the Artery
      • Disadvantages of Being Very Painful & Time-Consuming
  • Indications for Surgical Repair:
    • Rupture
    • Rapid Expansion
    • Nerve Compression
    • Skin Ischemia
  • If Infected (Mycotic): Excision
    • Most Common in IV Drug Users

Pseudoaneurysm 1

Pseudoaneurysm Doppler; (a) Pseudoaneurysm (Arrow), (b) Arterial Flow Across the Pseudoaneurysm 2

References

  1. Chengazi, H.U., Bhatt, A.A. Pathology of the carotid space. Insights Imaging 10, 21 (2019). Wikimedia Commons. (License: CC BY-4.0)
  2. Agarwala SR, Mohrir GS, Dotivala SJ. Posttraumatic pseudoaneurysm of popliteal artery following total knee arthroplasty. Indian J Orthop. 2013 Jan;47(1):101-3. (License: CC BY-NC-SA-3.0)