Pseudoaneurysm cards

Question 1

what is a pseudoaneurysm

Answer 1

Occurs when there is a breach to the arterial wall, resulting in an accumulation of blood between the tunica media and tunica adventitia of the artery.

Question 2

what can cause pseudoaneurysms

Answer 2

damage to the vessel wall, such as puncture following cardiac catheterisation or repeated injections to the vessel (from IVDU); other causes include trauma, regional inflammation, or vasculitis

Question 3

what is a herald bleed in terms of pseudoaneurysms

Answer 3

Any patient that reports they had bleeding from the pseudoaneurysm that has since stopped requires close monitoring and urgent management
as there is risk of rebleed

Question 4

what is the presentation of a pseudoaneurysm

Answer 4

Often present with a pulsatile lump which can be tender.
most commonly in the femoral artery

Question 5

how would an infected pseudoaneurysm present

Answer 5

erythematous and tender; purulent material may be discharging from any sinus opening present. The patient will likely have systemic features of sepsis.

Question 6

what is the risk associated with an infected pseudoaneurysm

Answer 6

higher risk of perforation so requires more urgent intervention
There is a risk of arterial compromise in the distal limb due to the pseudoaneurysm which would present as acute limb ischaemia (6Ps)

Question 7

what investigations should be done for a pseudoaneurysm

Answer 7

Distal pulse status
duplex ultrasound. CT imaging can be used if access is difficult with ultrasound.
For any infected pseudoaneurysm, ensure that routine bloods (FBC, CRP, U&Es, clotting) are sent, as well as blood cultures and a pus MC&S (if discharging). ensure sufficient blood units are cross-matched

Question 8

what management options are there for pseudoaneurysms

Answer 8

smaller pseudoaneurysms they can be monitored.

ultrasound-guided compression or thrombin injection.

Compression can be painful to do and requires 30 minutes of direct pressure of the neck of the pseudoaneurysm to reduce it

Endovascular stenting or surgery depend upon the patient and the location of the pseudoaneurysm. They can also leak causing persistent perfusion of the pseudoaneurysm, or migrate

Question 9

what is the management for infected pseudoaneurysms

Answer 9

If any evidence of discharge from the region, a pressure dressing should be applied and urgent imaging obtained

Infected pseudoaneurysms will require surgical ligation.

majority of patients will not develop acute limb ischaemia due to this, however occasionally a bypass graft will be required