Pseudoaneurysm: A review

Abstract

Pseudoaneurysms may arise from any artery in the human body. Most commonly found to involve the femoral artery after angiography, the presentation may vary from being clinically silent to a life-threatening emergency scenario. Recognition of this condition and treatment largely depend on the hemodynamic stability and anatomy of the pseudoaneurysm. Advances in treatment have enabled nonsurgical therapy in a significant number of cases. Ultrasound-guided thrombin injection is a fairly easy and effective treatment option. Other endovascular approaches, such as stent graft repair and coil embolization, are also available. Endovascular techniques play an important role in treating pseudoaneurysms arising from the aorta as a result of blunt trauma or previous aortic surgery. It is important to recognize the indications for surgery to avoid delay in the management of this potentially limb- or life-threatening condition.

Mycotic pseudoaneurysm by vancomycin-intermediateStaphylococcus aureus: a rare cause of persistent bacteraemia

“…Pseudoaneurysms are aetiologically classified as iatrogenic, traumatic, anastomotic or infected, with arterial catheterisation contributing to the largest incidence 2 3. The term mycotic aneurysm was first used by Sir William Osler in 1885 to describe a ‘fresh fungal vegetation’ and has since been used to describe infected non-syphilitic arterial aneurysms and pseudoaneurysms, not necessarily fungal 4 5.…”

“…The term mycotic aneurysm was first used by Sir William Osler in 1885 to describe a ‘fresh fungal vegetation’ and has since been used to describe infected non-syphilitic arterial aneurysms and pseudoaneurysms, not necessarily fungal 4 5. MPAs constitute <1% of all aneurysms, and are characterised anatomically by a sac or cavity and a neck communicating with the arterial lumen 2 6. MPAs have been reported from various vascular territories, but the femoral artery is the most common followed by the abdominal aorta 4–6.…”

“…Historically, infective endocarditis served as the most common aetiological basis; however, arterial catheterisation forms the largest share in modern practice 2–4. In addition to groin access for catheterisation, frequent use of femoral veins for intravenous drug abuse with erroneous arterial puncture increased the changes of femoral artery involvement 2. Peripheral MPAs are being more commonly reported due to the use of peripheral catheters for drug administration and haemodynamic monitoring 4.…”

“…Ultrasound with/without Doppler might not accurately define pathology and vessel compromise. Ultrasound requires visualisation of a neck or a hole feeding the false aneurysm, which requires operator expertise 2 3. Improper use can result in a misdiagnosis and catastrophic haemorrhage from subsequent anticoagulation for suspected DVT 1.…”

“…1 2 Multiple reports document a popliteal artery pseudoaneurysm being mistaken for an acute deep vein thrombosis (DVT) 1. We report a case of a superficial femoral artery (SFA) pseudoaneurysm super-infected with vancomycin-intermediate Staphylococcus aureus (VISA) mistakenly managed with anticoagulation, leading to potentially avoidable consequences.…”