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False aneurysm
Last reviewed: 23.04.2024
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False aneurysm (pseudoaneurysm, pulsating hematoma, PA) is the communication between the lumen of the artery and the adjacent connective tissue, which leads to the formation of a cavity filled with blood. The cavity of the hematoma does not contain structures of the normal wall of the artery (media and adventitia), which distinguishes it from the true aneurysm. The mechanism of PA formation is the resorption of the thrombus closing the puncture site. As a result, pulsating blood flow from the femoral artery during systole stretches surrounding tissues, forming a cavity communicating with the lumen of the artery, and during the diastole its decompression takes place.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]
Causes False aneurysm
Causes of a false aneurysm
Risk factors for developing a false aneurysm are the use of an introducer with a larger diameter, a combination of angiotrombotic drugs, a longer duration of the procedure, difficulties in performing femoral artery puncture, and anatomical features of the patient. The frequency of its development ranges from 0.1-0.2% in diagnostic coronary angiography and up to 0.5-6.3% (an average of 1%) in the case of PCI.
Symptoms False aneurysm
Symptoms of a false aneurysm
Clinically false aneurysm is manifested by pain in the inguinal region, although it can also be asymptomatic. A physically false aneurysm can be distinguished from a normal hematoma by the presence of a pulsating mass in the groin, as well as by the presence of local noise. However, in physical examination, up to 60% of PA is not diagnosed. Therefore, if a false aneurysm is suspected, the patient is given a color duplex scan of the puncture site. The U3-attributes of the PA include the detection of a message (the so-called cervix) between the lumen of a false aneurysm.
Treatment False aneurysm
Treatment of a false aneurysm
The clinical significance of a false aneurysm depends on its size. If the diameter of the PA is less than 2 cm, then after 2 weeks. It closes on its own in 50% of cases, and after 2 months. - in 90% of cases. Thus, in the absence of clinical symptoms in the case of small false aneurysms, a conservative tactic is possible, and only if the PA is preserved according to control ultrasound after 2 months. Observation of invasive tactics is recommended.
On the other hand, large false aneurysms can gradually increase and eventually burst with the development of peritoneal bleeding or the transfer of blood into the intermuscular spaces of the thigh. In addition, a false aneurysm can squeeze the surrounding neurovascular structures, which can lead to thrombosis of the femoral vein (with compression of the femoral vein) or neuropathy (with compression of the femoral nerve). In this case, the patient needs emergency surgical treatment.
Currently, most false aneurysms are treated with minimally invasive techniques. The most commonly used method of manual compression. Its essence consists of finger compression of the PA neck under the control of the ultrasound transducer, usually within 15-30 minutes, which leads to the closure of the communication between the artery lumen and the cavity of the false aneurysm. At the end of the procedure, a control ultrasound is performed. The frequency of closing the false aneurysm in this technique after the first attempt is 86%. In 5% of cases, ultimately, surgical treatment is required. The disadvantages of this method are its duration (up to 2 hours in some cases), the soreness of the procedure, the lack of complete closure in the case of large false aneurysms. Early relapses are also possible, especially in the case of PA more than 4 cm in diameter or on the background of intensive antithrombotic therapy. Relapses are mainly eliminated by repeated procedures.
Another way to treat a false aneurysm is to inject thrombin into the cavity of the PA under an ultrasound control. The success of the procedure is about 98%, in contrast to manual compression, the PA closes immediately after the injection. This method can be used for different sizes of PA (from 1.5 to 7.5 cm), as well as in the case of multi-chambered false aneurysms. Relapses occur in 5% of cases, they are successfully eliminated by repeated injection of thrombin. In general, the method is safe, but in the event of a drug falling into the main artery, thrombosis of the femoral artery or distal embolism is possible, which can lead to acute ischemia of the lower limb. Very rarely, thromboembolism of the pulmonary artery develops. Contraindications to the injection of thrombin is the presence of a false aneurysm of a wide or short neck, as well as arteriovenous fistula.
Prevention
Prevention of false aneurysm
The main measure of prevention of PA is accurate puncture of the common femoral artery (with puncture of a non-common femoral artery, and a superficial or deep femoral artery, the risk of developing a false aneurysm is higher), as well as careful observance of time and methods of haemostasis after removal of the introducer.