Pseudoaneurysm


Pseudoaneurysm

Description, Causes and Risk Factors:

A pseudoaneurysm is defined as a pulsating, encapsulated hematoma in communication with the lumen of a ruptured vessel. A ventricular pseudoaneurysm is a cardiac rupture contained and loculated by the pericardium, which forms its external wall. Pathologically, the wall of arterial pseudoaneurysm has been breached, and the external wall of the aneurysmal sac consists of outer arterial layers, perivascular tissue, blood clot, or layer of reactive fibrosis.

A pseudoaneurysm may be a complication of cardiac catheterization, a procedure in which a catheter is inserted in an artery in your groin (femoral artery) and is threaded through your blood vessels to your heart. Cardiac catheterization is used to capture images of your heart to diagnose heart disease and to treat certain types of heart diseases. A pseudoaneurysm can occur if blood leaks and pools outside your femoral artery where it was punctured when the catheter was inserted. Pseudoaneurysms can also occur in other arteries throughout the body related to either surgery or trauma, or from the rupture of an aneurysm.

Pseudoaneurysms can also occur in the heart chambers, such as the left ventricle, after damage from a heart attack causes blood to leak and pool outside the injured heart muscle.

If a pseudoaneurysm of a femoral artery related to cardiac catheterization is small, it may go undetected and not cause any complications. But if a small pseudoaneurysm is detected, your doctor may recommend a watchful-waiting approach to see if it resolves on its own. However, most often, when a femoral artery pseudoaneurysm is detected, your doctor will recommend one of these treatments:

Some pseudoaneurysms resolve themselves, though others require treatment to prevent hemorrhage, an uncontrolled leak or other complications. An ultrasound study in the Vascular Laboratory may be requested to evaluate a puncture site if swelling, pain or extensive bruising suggests a pseudoaneurysm may have developed.

Symptoms:

Symptoms of pseudoaneurysm include pain due to increased pressure from swelling or nerve compression, and extremity swelling due to venous compression. Further complications of pseudoaneurysms include deep venous thrombosis or rupture, the risk of which increases with increasing pseudoaneurysm size. Iatrogenic pseudoaneurysms occur in the upper extremity less than 2% of the time, yet this site is more likely to experience functional or neurological damage. Functional or neurological damage is less likely to occur if the axillary artery is avoided.

Diagnosis:

A comprehensive imaging strategy is required for patients with pseudoaneurysm. CT may be the first imaging technique that is performed for the diagnosis of pseudoaneurysm. Most pseudoaneurysms are saccular in shape. If angiography or endovascular treatment is required promptly, radiologists should try to reduce the total dose of contrast medium. Large pseudoaneurysms can be detected easily on contrast-enhanced CT, whereas small lesions can be overlooked easily. In such cases, angiography is required. Angiography allows confirmation of the site of the pseudoaneurysm and assessment of its suitability for immediate treatment with an interventional technique if needed.

CT angiography, MRI (including MR angiography), and sonography combined with color Doppler study are sometimes used for the diagnosis of pseudoaneurysm. However, MRI has not been as useful as CT angiography or sonography in the diagnosis of pseudoaneurysm because its use is limited by the poor clinical condition of patients. Sonography has been shown to improve the detection of pseudoaneurysm. Although the ability to perform the examination at the bedside and its relative low cost may make sonography an ideal first-line examination, the ability to diagnose pseudoaneurysm using sonography may depend on the location of the lesion and the skill of the operator.

Treatment:

Surgery is sometimes required, but most pseudoaneurysms at arterial puncture sites can be treated with a brief, minimally-invasive procedure performed under local anesthesia. Preparation takes a few minutes. The procedure will be explained and informed consent obtained. Ultrasound imaging guides placement of a needle into the pseudoaneurysm and then thrombin is injected. Thrombin is an enzyme that promotes rapid clot formation, immediately obliterating the pseudoaneurysm cavity when injected. There are some risks of an adverse reaction or clot formation in a major artery or vein (which might require urgent surgery), but the procedure is usually uncomplicated.

A follow-up Duplex scan is generally performed three to seven days after successful treatment. Further evaluation or treatment may be recommended if thrombin injection does not completely eliminate the pseudoaneurysm.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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