Pseudoaneurysms may arise from any artery in the human body. Most commonly found to involve the femoral artery after angiography, the presentation may vary from being clinically silent to a life-threatening emergency scenario. Recognition of this condition and treatment largely depend on the hemodynamic stability and anatomy of the pseudoaneurysm. Advances in treatment have enabled nonsurgical therapy in a significant number of cases. Ultrasound-guided thrombin injection is a fairly easy and effective treatment option. Other endovascular approaches, such as stent graft repair and coil embolization, are also available. Endovascular techniques play an important role in treating pseudoaneurysms arising from the aorta as a result of blunt trauma or previous aortic surgery. It is important to recognize the indications for surgery to avoid delay in the management of this potentially limb- or life-threatening condition.
Good midterm outcomes for moderately hypotensive and normotensive patients can be obtained using an EBC protocol for hypotension with a regionalized transport system directly to the operating room. Severely hemodynamically unstable rAAA patients still pose a significant challenge despite mitigation of hypotension by EBC, suggesting that survival may be compromised by factors other than hypotension alone. We still advocate for the use of EBC for all hypotensive patients as part of a defined rAAA protocol before definitive repair.
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