Iatrogenic Pseudoaneurysms: Optimal Management and Treatment Options

Abstract

Background Iatrogenic trauma is the most common cause of pseudoaneurysm. Several treatment methods are now available, including surgical repair, direct compression with the assistance of ultrasound, and ultrasound-guided thrombin injection. Each of these treatments has its own risks and advantages. Objective We sought to retrospectively assess the causes of pseudoaneurysm and the evolution of treatments and outcomes. Results Ninety-three pseudoaneurysms were diagnosed at Dunedin Public Hospital between September 1994 and December 2005, the majority resulting from cardiac catheterization. Fifteen patients were treated with ultrasound-guided compression, with a success rate of 66%. Sixty-three patients were treated with ultrasound-guided thrombin injection, with a success rate of 95%. No major or lasting complications were observed with either compression or thrombin injection; however, delayed diagnosis and treatment may have serious consequences requiring surgical salvage. Conclusions Ultrasound-guided thrombin injection is safe, effective, quick, and well tolerated by patients. It has become preferable to compression treatment and it is less invasive than surgical repair. Treatment should be given promptly upon diagnosis of the pseudoaneurysm rather than delaying with watchful expectation.

Stent-grafts in the management of life-threatening hemorrhage following inadvertent femoral catheterization in high-risk patients: report of two cases and review of the literature

“…Management of access site complications may include conservative therapy, percutaneous intervention, and/or vascular surgery 17. Ultrasound-guided compression can be used in minor injuries and stable patients; however, it has major limitations, including patient intolerance for those with compression pain, obese patients, and those who are receiving anticoagulants 16,18. Percutaneous ultrasound-guided thrombin injection is currently the method of choice in many centers for femoral pseudoaneurysms, with a 91% to 100% success rate in large series 9.…”

“… 17 Ultrasound-guided compression can be used in minor injuries and stable patients; however, it has major limitations, including patient intolerance for those with compression pain, obese patients, and those who are receiving anticoagulants. 16 , 18 Percutaneous ultrasound-guided thrombin injection is currently the method of choice in many centers for femoral pseudoaneurysms, with a 91% to 100% success rate in large series. 9 In obese patients with coagulopathy and hemodynamic instability, these methods are less successful in controlling active bleeding, and urgent surgical vascular repair is indicated.…”

SVU-CME Test Questions

“…2007;31:27-30 Fishing for bass: surveying primary physicians in the barriers to aortic screening study (Dueck et al). 2007;31:189-192 Iatrogenic pseudoaneurysms: optimal management and treatment options (Hill et al). 2007;31:131-135 The incidence of popliteal artery aneurysms in patients with abdominal aortic aneurysms (Grimm et al).…”