Pseudoaneurysms – Interventional Diagnosis, Management, Follow-Up 1

Background
Pseudoaneurysm is defined as a sac of turbulent blood flow surrounded by a single layer of fibrous tissue. Surgical repair used to be the mainstay of treatment; however, image-guided treatment is becoming the prevalent therapy.

The objective of a recent study was to present a review of the involvement of interventional radiology in the diagnosis, management, and follow-up of pseudoaneurysms.

The results have shown that repair of pseudoaneurysms has become less invasive with percutaneous and endovascular treatments of this disease.

Imaging Features
Ultrasound – Method of choice for initial evaluation. Hallmark finding is “ying-yang sign.”

MDCT - Can be a first-line method of evaluating pseudoaneurysms in the context of acute hemorrhage. Can be used for endovascular treatment planning.

Digital Subtraction Angiography – Used in cases of clinical instability.

Pretreatment Assessment
Patient’s clinical stability, local expertise, and equipment availability usually determines how a pseudoaneurysm is diagnosed. Characteristics such as size relative to the feeding vessel, the vascular territory, and the neck length and width are important.