This article is the third part of a three-part series on pseudoaneurysms. Part 1 provides an overview of pseudoaneurysms and brief discussion of the causes and diagnostic methods. Part 2 discusses in detail the four most common treatment methods. This article, Part 3, provides a brief overview and a listing of references.
A pseudoaneurysm, or "false aneurysm," should be suspected if a patient has a history of blunt or penetrating trauma or an endovascular procedure and presents with a pulsating, painful mass. Doppler ultrasound is an inexpensive first test to detect blood flow to the mass. And arteriography (dye mapping of the arteries) allows the doctor to see the location of the pseudoaneurysm.
Review of Treatment Options (see Part 2 for a complete description)
Surgical repair is preferred if reconstruction of damaged arteries is needed.
An endovascular approach allows for insertion of a covered stent (small tube) that blocks leakage of blood from the artery to the pseudoaneurysm.
Ultrasound-guided compression helps to clot off the connection to the pseudoaneurysm. However, it is often painful and takes 10-20 minutes of compression.
Ultrasound-guided thrombin injection is successful. Thrombin is injected into the pseudoaneurysm, causing it to clot off. It is no longer at risk of rupturing. Thrombin cannot be injected if an "arteriovenous fistula" is present, because thrombin could get into the venous system and cause clots in unwanted places (heart, brain).
Though pseudoaneurysms are rare, they are serious and must be diagnosed accurately and quickly. If the diagnosis is missed, the doctor may incise the mass, thinking that it is an infection (abscess), and life-threatening bleeding from the pseudoaneurysm could result. Many treatment options are available to the experienced vascular surgeon to obliterate the pseudoaneurysm yet maintain blood flow to the muscles and tissues that the nearby artery supplies.
Link to the Suite 101 article, Treatment of Pseudoaneurysms (Part 2).
References
- Hanson JM, Atri M, and N Power. Ultrasound-guided thrombin injection of iatrogenic groin pseudoaneurysm: Doppler features and technical tips. British J Rad 2008. 81:154-63.
- Kumar V et al. Posterior tibial artery pseudoaneurysm following tibial fracture. SICOT Online Report 2003. E039:1-7.
- Rosa P et al. Endovascular management of a peroneal artery injury due to a military fragment wound. Annals of Vascular Surgery 2003. 17(6):678-81.
- Saad NEA et al. Ultrasound diagnosis of arterial injuries and the role of minimally invasive techniques in their management. Ultrasound Clinics 2006. 1:183-99.
- Spirito R et al. Endovascular treatment of a post-traumatic tibial pseudoaneurysm and arteriovenous fistula: Case report and review of the literature. J Vasc Surg 2007. 45(5):1076-9.
- Van Hensbroek PB et al. Endovascular treatment of anterior tibial artery pseudoaneurysm following locking compression plating of the tibia. J Ortho Trauma 2007. 21(4):279-282.
- Wikipedia: Pseudoaneurysm
- U.C. Davis Vascular Center: Pseudoaneurysm evaluation and treatment.
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