Vascular I - Pseudoaneursym

Pseudoaneurysm

forms when blood escapes through a defect in the arterial wall, creating a pulsatile hematoma connected to the artery by a neck

Iatrogenic puncture and trauma

Common causes of pseudoaneurysm

Infection, suture failure, and repetitive cannulation

Risk factors of pseudoaneurysm

Indications

• Pain, swelling, tenderness

• Pulsatile mass near puncture site

• Bruit or thrill

Limitations

• Allergy to thrombin or bovine products

• Current anticoagulation

• Size and width of PA neck

• Distal limb ischemia

• Skin infection at PA site

Common femoral artery

Most common site

Abnormal post-injection

Persistent flow, recanalization, or new pseudoaneurysm

Normal post injection

Thrombosed cavity, patent native artery

Differential considerations

• Hematoma without communication to an artery

• Hyperemic lymph nodes

• Arteriovenous fistula

• Vascular mass

Surgical treatment

• Open repair

• Resection (HD access)

• Interposition grafts

Endovascular treatment

Covered stent

Medical treatment

• Thrombin injection or duplex-guided compression

• Follow-up observation for PA <2cm in diameter