Pseudoaneurysms – Interventional Diagnosis, Management, Follow-Up 2

Etiology
Iatrogenic - The incidence is 1% in diagnostic angiograms.

Trauma – For those who reach the hospital with an aortic transection, intravascular stenting is the new gold standard of care in many centers.

Vasculitis - Seen in Takayasu’s, in polyarteritis nodosa, Kawasaki’s disease, and Behçet’s disease.

Tumor - Osteochondromas, choriocarcinoma, lymphoma, lung cancer, and renal angiomyolipomas during pregnancy have a high rate of developing pseudoaneurysms.

Syndromes - Neurofibromatosis, Ehlers-Danlos type IV, Marfan syndrome, and segmental arterial mediolysis.

IV Drug Abusers - Surgery without use of synthetic materials is the treatment of choice.

Postsurgical - Para-anastomotic pseudoaneurysms are increasingly being repaired by endovascular means.

Atherosclerosis – Penetrating ulcers in the descending thoracic aorta may develop into pseudoaneurysms.

Therapeutic Options
Repair of the vascular defect with or without a patch is still the preferred treatment in cases with large hematomas with rapid expansion, distal arterial compromise, overlying skin or soft tissue ischemia, compartment syndrome, or failed endovascular intervention.

Ultrasound-Guided Compression - Good for common femoral pseudoaneurysms <4 cm.

Ultrasound-Guided Thrombin Injection - May work if the neck is <10 mm.

Transcatheter Arterial Embolization – Embolization materials include proximal blocking agents such as coils, glue, Onyx, Ethibloc, Gelfoam, and detachable balloons.

Endovascular Covered Stent – Pseudoaneurysms with wide necks may need a covered stent.

Follow-Up
Ultrasound and MDCT can be used to for follow-up of treated pseudoaneurysms, and it is usually done the day after and seven to 10 days later.

Reviewer’s Comments:
In conclusion, a variety of modalities can be used to diagnose pseudoaneurysms, and a variety of endovascular and percutaneous methods can be used to repair pseudoaneurysms with high success rates and low morbidity.

Interventional radiology approach is now becoming the main method of therapy for pseudoaneurysms in almost all vascular territories.

Author: Sharon Gonzales, MD

Reference
Keeling AN, McGrath FP, Lee MJ. Interventional Radiology in the Diagnosis, Management, and Follow-Up of Pseudoaneurysms.
Cardiovasc Intervent Radiol; 2009;32 (January-February): 2-18: