A 10‐year retrospective review of management and outcomes of pseudoaneurysms at a tertiary referral centre

Abstract

Introduction Pseudoaneurysms are uncommon but potentially life‐threatening. Treatment may involve a variety of interventions including observation, manual compression, ultrasound‐guided thrombin injection and a variety of endovascular and surgical techniques. Current treatments are largely based on observational data and there is no consensus on management. This study aimed to provide evidence for guiding clinical decisions regarding visceral artery pseudoaneurysm and peripheral artery pseudoaneurysm management. Methods Retrospective single‐centre review of patients diagnosed with visceral and peripheral artery pseudoaneurysms at a tertiary hospital (2010–2020). Results There were 285 patients included in this study. A total of 86 patients were diagnosed with a visceral artery pseudoaneurysm, and 49 of these (57%) were caused by trauma. A total of 199 patients were identified with a peripheral pseudoaneurysm; 76 of these (38%) were caused by trauma and 69 (35%) were due to access site complication during an endovascular procedure. Initial technical success was achieved in 266 patients (93.3%) with 19 requiring an additional treatment to achieve success. Conservative treatment (100% success), endovascular treatment (98.1%) and surgery (100%) were more successful than ultrasound‐guided compression (63.6%) and thrombin injection (83.8%). The median time from diagnosis to intervention was <9 h for visceral artery pseudoaneurysms and 24 h for peripheral artery pseudoaneurysms. There was no change in survival outcomes with respect to time from diagnosis and intervention. Conclusion In this study, pseudoaneurysms were treated with a high degree of success by observation or by using an endovascular approach, and those requiring endovascular intervention did not need to be treated immediately in an emergent setting.

Femoral artery Pseudo-aneurysm: Presentation, Causation and Outcome in Cardiothoracic Vascular and Transplant Centre of a Tertiary Level Hospital in Nepal

“…Over the two years our study has reviewed, the incidence of femoral artery pseudo-aneurysm is found to be higher than that of most other centers who have conducted such studies. 1,5,6 This can be attributed to our Center being the only vascular center of the country. And thus the referral center for every vascular pathology and emergency.…”

“…This has led to high incidence of femoral artery pseudo-aneurysm. 1,5,7,8 Most patients with femoral artery pseudo-aneurysms present with tender/painful mass over the groin or a pulsatile swelling. 1,3,5 Patients in our center are referred from various cities of Nepal.…”

“…1,5,7,8 Most patients with femoral artery pseudo-aneurysms present with tender/painful mass over the groin or a pulsatile swelling. 1,3,5 Patients in our center are referred from various cities of Nepal. Due to referral delay or transportation they usually present late with signs/ symptoms of limb ischemia, infection, shock and sepsis.…”

Point of Care Ultrasound Diagnosis of Maxillary Artery Pseudoaneurysm in the Emergency Department

“…Endovascular embolization uses embolic agents to temporarily or permanently occlude the vessel and promote thrombus formation 30 , 31 , 32 , 33 . There is no definitive consensus for the management of pseudoaneurysms 34 . In this patient’s case, the location of the pseudoaneurysm on the face was not conducive to surgical exploration.…”

CIRSE Standards of Practice for the Endovascular Treatment of Visceral and Renal Artery Aneurysms and Pseudoaneurysms

“…Conservative management of small VAPAs within the parenchyma may be reasonable but strict follow-up must be performed to monitor their evolution [ 19 ].…”