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Ultrasound of the Month: Radial Pseudoaneurysm

Prevention of pseudoaneurysms formation is noted in the literature as first line management. Post procedure, prolonged compression of the puncture site with limb rest is typically sufficient to prevent pseudoaneurysm formation. In anticoagulated patients, the length of compression is extended. If these measures fail, secondary treatment is needed. Historically, surgical management was the gold standard treatment for pseudoaneurysms. However, in recent years, less invasive treatments have been preferred by vascular surgeons with excellent clinical outcomes.

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Articles of Interest

Iatrogenic Pseudoaneurysms

Pseudoaneurysms are typically the result of traumatic arterial injury. With the increasing utilisation of percutaneous arterial interventions worldwide, iatrogenic arterial injury has become the predominant cause of pseudoaneurysm formation.

Interventional treatment options in pseudoaneurysms: different techniques in different localizations

Pseudoaneurysms may occur in any damaged vessel including the carotid, extremity and visceral arteries. Conventional angiography is still the gold standard method for diagnosis, but other imaging modalities such as duplex Doppler ultrasonography (US), magnetic resonance (MR) angiography and computed tomographic (CT) angiography are effective in noninvasive detection. Early diagnosis is essential when considering the ruinous consequences of pseudoaneurysms.

Percutaneous Thrombin Injection for Closure of Femoral Pseudoaneurysms: Preliminary Experience

The method is relatively easy and does not require sedation or intravenous analgesia, and has a low incidence of recurrence. The principal inconvenience of this method is the risk of intra-arterial injection, with the consequent vascular thrombosis.

Pseudoaneurysms and the Role of Minimally Invasive Techniques in Their Management

Therapeutic options have evolved in recent years from the traditional surgical option toward a less invasive approach and include radiologic procedures such as US-guided compression, US-guided percutaneous thrombin injection, and endovascular management (embolization, stent-graft placement).

Resources

Critical Care Sonography

Unlike true aneurysms, pseudoaneurysms are surrounded by haematoma, not by the vessel wall. They are in effect a contained collection of blood. Pseudoaneurysms are a result of blood vessel wall damage, most often iatrogenically caused by blood vessel puncture.

Radiopaedia

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.

StatPearls

Pseudoaneurysms are false aneurysms that occur at the site of arterial injury. They are unlike true aneurysms as a layer of the arterial wall does not contain them.