Pseudoaneurysms and the Role of Minimally Invasive Techniques in Their Management

Abstract

Pseudoaneurysms are common vascular abnormalities that represent a disruption in arterial wall continuity. Some complications associated with pseudoaneurysms develop unpredictably and carry high morbidity and mortality rates. The advent of new radiologic techniques with a greater sensitivity for asymptomatic disease has allowed more frequent diagnosis of pseudoaneurysms. Conventional angiography remains the standard of reference for diagnosis but is an invasive procedure, and noninvasive diagnostic modalities (eg, ultrasonography [US], computed tomographic angiography, magnetic resonance angiography) should be included in the initial work-up if possible. A complete work-up will help in determining the cause, location, morphologic features, rupture risk, and clinical setting of the pseudoaneurysm; identifying any patient comorbidities; and evaluating surrounding structures and relevant vascular anatomy, information that is essential for treatment planning. Therapeutic options have evolved in recent years from the traditional surgical option toward a less invasive approach and include radiologic procedures such as US-guided compression, US-guided percutaneous thrombin injection, and endovascular management (embolization, stent-graft placement). The use of noninvasive treatment has led to a marked decrease in the morbidity and mortality rates for pseudoaneurysms.

Radial Artery Pseudoaneurysm Managed by prolonged Ultrasound Guided Compression Repair Aided by Interval Application of Compression Device

“…This allows early therapeutic intervention before complications of pseudoaneurysms can manifest. 3,4 Moreover, pseudoaneurysms themselves have become more common due to the increased number of interventional procedures and the more frequent use of continued anticoagulation. 5 There are a variety of modalities available for treatment of pseudoaneurysms.…”

“…Complications include thromboembolic events due to thrombin flowing into the arterial system leading to thrombosis of distal vessels and allergic reactions such as generalised urticaria and anaphylaxis. 2,4 Contraindications to the procedure include known allergic reaction to thrombin, presence of…”

Femoral Artery Pseudoaneurysm Rupture: A Catastrophic Complication Excluded with Endovascular Stenting: Case Report

“…1,3 Psö do a nev riz ma in si dan sı nı ar tı ran fak tör ler ara sın da ponk si yon tek ni ği, kom pres yon tek ni ği, kul la nı lan she at ka lın lı ğı gi bi an ji og ra fi uy gu la yı -cı sı na bağ lı özel lik ler var dır. Bir kıs mı ise yay gın pe ri fe ral ar ter has ta lı ğı, hi per tan si yon, obe si te, anti ko a gü lan kul la nı mı, trom bo si to pe ni gi bi has ta ile il gi li fak tör ler dir.…”

“…1,4,5 Psö do a nev riz ma la rın ço ğu spontan ola rak trom bo ze olup ka pa nır ken, ka pan ma yan yak la şık %10-20 va ka te da vi ge rek ti rir. 7,8 Psö do a nev riz ma la rın te da vi yön tem le ri arasın da Dopp ler ul tra so nog ra fi eş li ğin de kom presyon, Dopp ler ul tra so nog ra fi eş li ğin de trom bin en jek si yo nu, en do vas kü ler em bo li zas yon ve stentgreft le me, cer ra hi yön tem ler (li gas yon, re zek si yon ve greft le me) sa yı la bi lir.…”

Intrapancreatic pseudoaneurysm causing massive gastrointestinal hemorrhage and chronic pancreatitis

“…The natural course of an intrapancreatic pseudoaneurysm is unpredictable and spontaneous rupture may cause mortality with high rates, particularly in morbid post-surgical patients (5). Therefore, treatment of an identified pseudoaneurysm as soon as possible is recommended (5).…”