Skip to main content
SpringerLink
Log in

Peripheral Pseudoaneurysms

  • Chapter
  • First Online:
Mastering Endovascular Techniques

  • 62 Accesses

Abstract

Peripheral pseudoaneurysms are a frequent vascular complication that may occur as a consequence of traumatic injuries, infections, or iatrogenic procedures. Pseudoaneurysms are aberrant protrusions in a blood vessel that are generated by a disruption in the vessel wall. They can present in various parts of the vasculature and have the potential to cause significant morbidity if left untreated. Percutaneous and endovascular interventions are becoming more recognized as effective treatment for peripheral pseudoaneurysms, leading to reduction in morbidity and improvement of patient outcomes.

Percutaneous interventions, such as ultrasound-guided compression, thrombin injection, or mechanical compression, entail the external induction of thrombosis. For pseudoaneurysms of a small to moderate size, these methods have been found to be safe and efficacious, with low recurrence rates. However, larger, and more complex, pseudoaneurysms may necessitate endovascular methods, such as stent-graft placement or coil embolization, which are minimally invasive procedures executed under fluoroscopy guidance.

These approaches offer distinct advantages over conventional surgical procedures, including shorter hospital stays, faster recovery, and decreased complication rates.

The choice of intervention should be individualized based on the patient’s clinical condition as well as the anatomical features (size, location, complexity) of the pseudoaneurysm, with careful monitoring for post-procedural outcomes and optimal long-term treatment outcomes.

This chapter serves as an overview of percutaneous and endovascular procedures that are used for the management of peripheral pseudoaneurysms.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kang SS, Labropoulos N, Mansour MA, Michelini M, Filliung D, Baubly MP, Baker WH. Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms. J Vasc Surg. 2000;31:289–98.

    Article  CAS  PubMed  Google Scholar 

  2. Krüger K, Zähringer M, Söhngen F-D, Gossmann A, Schulte O, Feldmann C, Strohe D, Lackner K. Femoral pseudoaneurysms: management with percutaneous thrombin injections—success rates and effects on systemic coagulation. Radiology. 2003;226:452–8.

    Article  PubMed  Google Scholar 

  3. Morgan R, Belli A-M. Current treatment methods for postcatheterization pseudoaneurysms. J Vasc Interv Radiol. 2003;14:697–710.

    Article  PubMed  Google Scholar 

  4. Jayaraman S, Richardson D, Conrad M, Eichler C, Schecter W. Mycotic pseudoaneurysms due to injection drug use: a ten-year experience. Ann Vasc Surg. 2012;26:819–24.

    Article  PubMed  Google Scholar 

  5. Biancari F, D’Andrea V, di Marco C, Savino G, Tiozzo V, Catania A. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J. 2010;159:518–31.

    Article  PubMed  Google Scholar 

  6. Peters S, Braun-Dullaeus R, Herold J. Pseudoaneurysm Hämostaseologie. 2017;38(3):166–72. https://doi.org/10.5482/HAMO-17-01-0006.

    Article  Google Scholar 

  7. Stone PA, Campbell JE, AbuRahma AF. Femoral pseudoaneurysms after percutaneous access. J Vasc Surg. 2014;60:1359–66.

    Article  PubMed  Google Scholar 

  8. Abu-Yousef M, Wiese J, Shamma A. The “to-and-fro” sign: duplex Doppler evidence of femoral artery pseudoaneurysm. Am J Roentgenol. 1988;150:632–4.

    Article  CAS  Google Scholar 

  9. Soto JA, Múnera F, Morales C, Lopera JE, Holguín D, Guarín O, Castrillón G, Sanabria A, García G. Focal arterial injuries of the proximal extremities: helical CT arteriography as the initial method of diagnosis. Radiology. 2001;218:188–94.

    Article  CAS  PubMed  Google Scholar 

  10. Toursarkissian B, Allen BT, Petrinec D, Thompson RW, Rubin BG, Reilly JM, Anderson CB, Flye MW, Sicard GA. Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. J Vasc Surg. 1997;25:803–9.

    Article  CAS  PubMed  Google Scholar 

  11. Middleton WD, Dasyam A, Teefey SA. Diagnosis and treatment of iatrogenic femoral artery pseudoaneurysms. Ultrasound Q. 2005;21:3–17.

    PubMed  Google Scholar 

  12. Fellmeth BD, Roberts AC, Bookstein JJ, Freischlag JA, Forsythe JR, Buckner NK, Hye RJ. Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression. Radiology. 1991;178:671–5.

    Article  CAS  PubMed  Google Scholar 

  13. Saad NEA, Saad WEA, Davies MG, Waldman DL, Fultz PJ, Rubens DJ. Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics. 2005;25:S173–89.

    Article  PubMed  Google Scholar 

  14. Eisenberg L, Paulson EK, Kliewer MA, Hudson MP, DeLong DM, Carroll BA. Sonographically guided compression repair of pseudoaneurysms: further experience from a single institution. Am J Roentgenol. 1999;173:1567–73.

    Article  CAS  Google Scholar 

  15. la Perna L, Olin JW, Goines D, Childs MB, Ouriel K. Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. Circulation. 2000;102:2391–5.

    Article  PubMed  Google Scholar 

  16. Gale SS, Scissons RP, Jones L, Salles-Cunha SX. Femoral pseudoaneurysm thrombin injection. Am J Surg. 2001;181:379–83.

    Article  CAS  PubMed  Google Scholar 

  17. Brophy DP, Sheiman RG, Amatulle P, Akbari CM. Iatrogenic femoral pseudoaneurysms: thrombin injection after failed US-guided compression. Radiology. 2000;214:278–82.

    Article  CAS  PubMed  Google Scholar 

  18. Coley BD, Roberts AC, Fellmeth BD, Valji K, Bookstein JJ, Hye RJ. Postangiographic femoral artery pseudoaneurysms: further experience with US-guided compression repair. Radiology. 1995;194:307–11.

    Article  CAS  PubMed  Google Scholar 

  19. Gilbertson JJ, Sorrell KA, Feinberg RL, Wheeler JR, Gregory RT, Snyder SO, Gayle RG. Color-flow duplex-directed manual occlusion of femoral false aneurysms. J Vasc Surg. 1993;17:a39244.

    Article  Google Scholar 

  20. Schneider C, Malisius R, Küchler R, Lampe F, Krause K, Bahlmann E, Kuck K-H. A prospective study on ultrasound-guided percutaneous thrombin injection for treatment of iatrogenic post-catheterisation femoral pseudoaneurysms. Int J Cardiol. 2009;131:356–61.

    Article  PubMed  Google Scholar 

  21. Reeder SB, Widlus DM, Lazinger M. Low-dose thrombin injection to treat iatrogenic femoral artery pseudoaneurysms. Am J Roentgenol. 2001;177:595–8.

    Article  CAS  Google Scholar 

  22. Lennox AF, Delis KT, Szendro G, Griffin MB, Nicolaides AN, Cheshire NJ. Duplex-guided thrombin injection for iatrogenic femoral artery pseudoaneurysm is effective even in anticoagulated patients. Br J Surg. 2002;87:796–801.

    Article  Google Scholar 

  23. Clark TWI, Abraham RJ. Thrombin injection for treatment of brachial artery Pseudoaneurysm at the site of a hemodialysis fistula: report of two patients. Cardiovasc Intervent Radiol. 2000;23:396–400.

    Article  CAS  PubMed  Google Scholar 

  24. Sheiman RG, Brophy DP, Perry LJ, Akbari C. Thrombin injection for the repair of brachial artery pseudoaneurysms. AJR Am J Roentgenol. 1999;173:1029–30.

    Article  CAS  PubMed  Google Scholar 

  25. Cope C, Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection. Am J Roentgenol. 1986;147:383–7.

    Article  CAS  Google Scholar 

  26. Paulson EK, Nelson RC, Mayes CE, Sheafor DH, Sketch MH, Kliewer MA. Sonographically guided thrombin injection of latrogenic femoral pseudoaneurysms. Am J Roentgenol. 2001;177:309–16.

    Article  CAS  Google Scholar 

  27. Khoury M, Rebecca A, Greene K, Rama K, Colaiuta E, Flynn L, Berg R. Duplex scanning–guided thrombin injection for the treatment of iatrogenic pseudoaneurysms. J Vasc Surg. 2002;35:517–21.

    Article  PubMed  Google Scholar 

  28. Mohler ER, Mitchell ME, Carpenter JP, Strandness DE, Jaff MR, Beckman JA, Gerhard-Herman M. Therapeutic thrombin injection of pseudoaneurysms: a multicenter experience. Vasc Med. 2001;6:241–4.

    Article  PubMed  Google Scholar 

  29. Webber GW, Jang J, Gustavson S, Olin JW. Contemporary management of postcatheterization pseudoaneurysms. Circulation. 2007;115:2666–74.

    Article  PubMed  Google Scholar 

  30. Quarmby JW, Engelke C, Chitolie A, Morgan RA, Belli AM. Autologous thrombin for treatment of pseudoaneurysms. Lancet. 2002;359:946–7.

    Article  CAS  PubMed  Google Scholar 

  31. Friedman SG. Ultrasound-guided thrombin injection is the treatment of choice for femoral pseudoaneurysms. Arch Surg. 2002;137:462.

    Article  CAS  PubMed  Google Scholar 

  32. Sadiq S, Ibrahim W. Thromboembolism complicating thrombin injection of femoral artery Pseudoaneurysm: management with Intraarterial thrombolysis. J Vasc Interv Radiol. 2001;12:633–6.

    Article  CAS  PubMed  Google Scholar 

  33. Paulson EK, Sheafor DH, Kliewer MA, Nelson RC, Eisenberg LB, Sebastian MW, Sketch MH. Treatment of iatrogenic femoral arterial pseudoaneurysms: comparison of US-guided thrombin injection with compression repair. Radiology. 2000;215:403–8.

    Article  CAS  PubMed  Google Scholar 

  34. Elford J, Burrell C, Freeman S, Roobottom C. Human thrombin injection for the percutaneous treatment of iatrogenic pseudoaneurysms. Cardiovasc Intervent Radiol. 2002;25:115–8.

    Article  PubMed  Google Scholar 

  35. O’Sullivan GJ, Ray SA, Lewis JS, Lopez AJ, Powell BW, Moss AH, Dormandy JA, Belli AM, Buckenham TM. A review of alternative approaches in the management of iatrogenic femoral pseudoaneurysms. Ann R Coll Surg Engl. 1999;81:226–34.

    PubMed  PubMed Central  Google Scholar 

  36. Lemaire J-M, Dondelinger RF. Percutaneous coil embolization of iatrogenic femoral arteriovenous fistula or pseudo-aneurysm. Eur J Radiol. 1994;18:96–100.

    Article  CAS  PubMed  Google Scholar 

  37. Kobeiter H, Lapeyre M, Becquemin J-P, Mathieu D, Melliere D, Desgranges P. Percutaneous coil embolization of postcatheterization arterial femoral pseudoaneurysms. J Vasc Surg. 2002;36:127–31.

    Google Scholar 

  38. Jeon YS, Kim JY, Cho SG. Percutaneous treatment of a femoral artery pseudoaneurysm using the StarClose vascular closure system. Catheter Cardiovasc Interv. 2012;80:872–5.

    Article  PubMed  Google Scholar 

  39. Robken J, Shammas N. Novel technique to treat common femoral artery pseudoaneurysm using Angio-seal closure device. Int J Angiol. 2014;25:266–70.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Thalhammer C, Kirchherr AS, Uhlich F, Waigand J, Gross CM. Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation of endovascular covered stents. Radiology. 2000;214:127–31.

    Article  CAS  PubMed  Google Scholar 

  41. Yamakado K, Nakatsuka A, Tanaka N, Takano K, Matsumura K, Takeda K. Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol. 2000;11:66–72.

    Article  CAS  PubMed  Google Scholar 

  42. Lumsden AB, Miller JM, Kosinski AS, Allen RC, Dodson TF, Salam AA, Smith RB. A prospective evaluation of surgically treated groin complications following percutaneous cardiac procedures. Am Surg. 1994;60:132–7.

    CAS  PubMed  Google Scholar 

  43. Stone PA, Martinez M, Thompson SN, Masinter D, Campbell JE, Campbell JR, Aburahma AF. Ten-year experience of vascular surgeon management of iatrogenic pseudoaneurysms: do anticoagulant and/or antiplatelet medications matter? Ann Vasc Surg. 2016;30:45–51.

    Article  PubMed  Google Scholar 

  44. Sharma NK, Chin KF, Modgill VK. Pseudoaneurysms of the femoral artery: recommendation for a method of repair. J R Coll Surg Edinb. 2001;46:195–7.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Enrico Moschovakis-Zeiger and Iason Anastassiou for their assistance in the preparation of the illustrations.

Author information

Authors and Affiliations

  1. 2nd Department of Radiology, National and Kapodistrian University, “ATTIKON” University General Hospital, Athens, Greece

    Ornella Moschovaki-Zeiger, Nikolaos Achilleas Arkoudis, Stavros Spiliopoulos, Konstantinos Palialexis & Elias Brountzos

Authors
  1. Ornella Moschovaki-Zeiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikolaos Achilleas Arkoudis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stavros Spiliopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Konstantinos Palialexis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elias Brountzos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ornella Moschovaki-Zeiger .

Editor information

Editors and Affiliations

  1. National and Kapodistrian University of Athens, Athens, Greece

    George Geroulakos

  2. Department of Vascular Surgery, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Efthymios Avgerinos

  3. Henri Mondor Hôspital, APHP Créteil, Hôpital Privé Paris East, Ramsay Santé, Créteil, France

    Jean Pierre Becquemin

  4. Vascular and Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK

    Gregory C. Makris

  5. Vascular Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Alberto Froio

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Moschovaki-Zeiger, O., Arkoudis, N.A., Spiliopoulos, S., Palialexis, K., Brountzos, E. (2024). Peripheral Pseudoaneurysms. In: Geroulakos, G., Avgerinos, E., Becquemin, J.P., Makris, G.C., Froio, A. (eds) Mastering Endovascular Techniques. Springer, Cham. https://doi.org/10.1007/978-3-031-42735-0_35

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-42735-0_35

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-42734-3

  • Online ISBN: 978-3-031-42735-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation