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(Circulation. 2007;115:2666-2674.)
© 2007 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Contemporary Management of Postcatheterization Pseudoaneurysms

Geoffrey W. Webber, MD; James Jang, MD; Susan Gustavson, RVT; Jeffrey W. Olin, DO

From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-José and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY

Correspondence to Dr Jeffrey W. Olin, DO, Professor of Medicine, Director, Vascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute and the Marie-José and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, One Gustave L. Levy Pl, Box 1033, New York, NY 10029. E-mail jeffrey.olin@msnyuhealth.org

Key Words: aneurysm • arteries • imaging • peripheral vascular disease • thrombin • thrombosis • vasculature

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
A pseudoaneurysm (PSA) is a contained rupture; there is a disruption in all 3 layers of the arterial wall (Figure 1). PSAs may occur under 4 circumstances: (1) after catheterization (Figure 2); (2) at the site of native artery and synthetic graft anastomosis (eg, aortofemoral bypass graft); (3) trauma; and (4) infection (eg, mycotic PSA) (Figure 3). This review will focus on PSAs that occur after cardiac and peripheral endovascular procedures. PSAs occur when an arterial puncture site does not adequately seal. Pulsatile blood tracks into the perivascular space and is contained by the perivascular structures, which then take on the appearance of a sac. Hematoma and the surrounding tissue form the wall of the PSA.

View larger version (70K):   Figure 1. Artist’s rendition of a postcatheterization PSA with proper placement of the needle for thrombin injection. There is a disruption in all 3 layers of the arterial wall. In essence, this represents a contained rupture.

View larger version (135K):   Figure 2. Arteriogram that demonstrates an axillary artery PSA after a diagnostic arteriographic procedure. Note the disruption in the vessel wall (white arrow) and the larger PSA sac (black arrow).

View larger version (62K):   Figure 3. Ultrasound of a spontaneous PSA in the left brachial artery. Note the absence of a tract. The PSA chamber is directly connected to the brachial artery. This type of PSA must be treated surgically. This patient had infective endocarditis.

Postcatheterization PSA is one of the most common vascular complications of cardiac and peripheral angiographic procedures. The incidence of PSA after . . . [Full Text of this Article]