Pseudoaneurysm Management

Abstract

False aneurysms, also known as pseudoaneurysms, are abnormal outpouchings or dilatation of arteries which are bounded only by the tunica adventitia, the outermost layer of the arterial wall. These are distinguished from true aneurysms, which are bounded by all three layers of the arterial wall. Pseudoaneurysms typically occur when there is a breach in the vessel wall such that blood leaks through the inner wall but is contained by the adventitia or surrounding perivascular soft tissue. Etiology

trauma (dissection or laceration) iatrogenic (dissection, laceration or

puncture)

arterial catheterization - accounts for most iatrogenic pseudoaneurysms 4 biopsy, surgery

spontaneous dissection fibromuscular dysplasia (dissection) mycotic aneurysm (inflammatory digestion

of the vessel wall)

myocardial infarction (left ventricular false

aneurysm)

regional inflammatory process

acute pancreatitis chronic pancreatitis

vessel injury/erosion due to a tumor:

relatively uncommon

vasculitides 4

Behcet syndrome giant cell arteritis Takayasu arteritis systemic lupus erythematosus polyarteritis nodosa

penetrating atherosclerotic ulcer

treatment:

In the past, early surgical repair was recommended for the treatment of almost all pseudoaneurysms Recently, endovascular techniques have been widely used for the treatment of pseudoaneurysms because these techniques are minimally invasive and have a high success rate and are associated with low mortality in interventional radiology we have multiple options to cure these pseudoaneurysms such as embolization with coils or particles, and using covered stent , combination of a balloon or an uncovered (“bare- mesh") stent placed across the arterial defect and packing the aneurysmal sac or direct injection of thrombin to pseudoaneurysm sac Sandwich Occlusion This technique, which is most easily performed by placing metallic coils on either side of the aneurysm, is one that has been used more than any other and, when performed correctly, will be curative with little risk of recurrence.