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Traumatic Pseudoaneurysms

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  • • Arterial access for catheter procedures has risk of pseudoaneurysm formation

    • Pseudoaneurysms are arterial disruptions contained by fibrotic tissue

    • Most resolve spontaneously

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Intra-Arterial Injections

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  • • Seen among injecting drug abusers

    • Brachial and femoral most common

    • Vessel vasoconstriction results in thrombosis and distal ischemia

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Epidemiology

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  • • Percutaneous catheter-based procedures and anticoagulation: Increased frequency of pseudoaneurysms

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Symptoms and Signs

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Pseudoaneurysm

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  • • Mass, may be pulsating

    • Bleeding

    • Pain

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Intra-Arterial Injection

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  • • Burning pain of limb

    • Gangrene of digits

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Imaging Findings

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  • • Duplex US can identify ongoing leak, patency of vessel

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  • • Evaluate for distal ischemia or embolus

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  • • Physical exam

    • Duplex US

    • Arteriography (rarely)

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Pseudoaneurysms

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  • • Most resolve spontaneously

    • US-guided compression can occlude the pseudoaneurysm leading to thrombosis and cure

    • Operative therapy, if indicated, includes primary repair of artery versus interposition graft

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Intra-Arterial Injection

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  • • If needle is still in place, irrigate with heparinized saline

    • Intra-arterial vasodilators to reduce spasm

    • Late complications, such as infection, treated by excision and ligation

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Surgery

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Indications

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  • • Distal ischemia

    • Severe infection of pseudoaneurysm

    • Ongoing hemorrhage

    • Local integumentary/neurologic compromise

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Complications

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  • • Infection, pseudoaneurysm formation, chemical endarteritis late complications of intra-arterial injection

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References

Hye RJ. Compression therapy for acute iatrogenic femoral pseudoaneurysms. Semin Vasc Surg. 2000;13:58.  [PubMed: 10743892]

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