Pseudoaneurysm of peripheral arteries: Our experience in a community-based hospital

• Main Authors: Lokesh Shekher Jaiswal, Narendra Pandit, Jagat Narayan Prasad, Shailesh Adhikary
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Indian Journal of Vascular and Endovascular Surgery
• Subjects: Iatrogenic; intravenous drug abuse; peripheral artery; pseudoaneurysm; surgery
• Online Access: http://www.indjvascsurg.org/article.asp?issn=0972-0820;year=2019;volume=6;issue=2;spage=102;epage=106;aulast=Jaiswal

Introduction: Pseudoaneurysms are false aneurysm where disruption in the arterial wall forms a localized pulsatile hematoma connecting the artery. The common causes are intravenous drug abuse (IVDA), iatrogenic (vascular interventions and surgery), trauma, and infections. Aims: The aim of this study was to analyze the etiology, management, and outcome of patients with pseudoaneurysms of peripheral arteries. Materials and Methods: This is a retrospective analysis of prospectively maintained database of 32 patients with peripheral artery pseudoaneurysms over 45 months at a community-based hospital of Eastern Nepal. Results: The most common site involved was femoral artery (56.3%) followed by brachial (15.6%), radial (6.3%), anterior tibial (6.3%), and others (15.5%). The common etiologies were iatrogenic (46.9%), IVDA (31.3%), trauma (18.7%), and infection (3.1%). Operative intervention was performed in 29 (90.6%) patients as follows: ligation of artery and debridement (46.9%), primary repair (28.1%), and venous graft bypass (15.6%). Three patients (9.4%) with noninfected iatrogenic pseudoaneurysms of <3 cm were managed conservatively. Infected pseudoaneurysms were seen in 14 (43.7%) patients. Staphylococcus aureus was the most common isolate in the culture. There was no reoperation, amputation, or any in-hospital mortality. At follow-up, one patient developed leg claudication pain following a femoral artery ligation and one of the five patients developed a graft thrombosis after an autologous reversed saphenous vein bypass graft without any sequelae. Conclusion: Although repair with distal revascularization is an ideal approach, debridement and simple ligation of pseudoaneurysms is a safer alternative especially in IV drug abusers.