Arterial Trauma, Iatrogenic

Traumatic Pseudoaneurysms

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

  • Pseudoaneurysms are arterial disruptions contained by fibrotic tissue

  • Most resolve spontaneously

Intra-Arterial Injections

• • Seen among injecting drug abusers

  • Brachial and femoral most common

  • Vessel vasoconstriction results in thrombosis and distal ischemia

Epidemiology

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

Symptoms and Signs

Pseudoaneurysm

• • Mass, may be pulsating

  • Bleeding

  • Pain

Intra-Arterial Injection

• • Burning pain of limb

  • Gangrene of digits

Imaging Findings

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

• • Evaluate for distal ischemia or embolus

• • Physical exam

  • Duplex US

  • Arteriography (rarely)

Pseudoaneurysms

• • 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

Intra-Arterial Injection

• • 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

Surgery

Indications

• • Distal ischemia

  • Severe infection of pseudoaneurysm

  • Ongoing hemorrhage

  • Local integumentary/neurologic compromise

Complications

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

References