Pseudoaneurysms

About Pseudoaneurysms

A pseudoaneurysm, or false aneurysm, develops when an injury to the wall of an artery allows blood to leak into the surrounding tissues, forming a contained pulsatile collection beneath the skin. Unlike a true aneurysm, where the entire vessel wall weakens and bulges, false aneurysm treatment focuses on a defect that communicates with the artery through a small hole, often the result of repeated needle punctures or catheter procedures.

Common causes include repeated cannulation in patients on long-term dialysis, particularly in the femoral artery in the groin and the brachial artery near an arteriovenous fistula at the elbow. Pseudoaneurysms can also follow orthopaedic surgery and various interventional procedures. Risk increases with anticoagulation, infection, and repeated trauma at the same site. Early recognition is important to avoid enlargement, rupture, or distal embolic complications.

Patients usually notice a tender, pulsatile swelling at the site of previous needle access, sometimes with bruising or a localised bruit. Color Doppler ultrasound is the primary tool for vascular swelling treatment planning, allowing us to distinguish a pseudoaneurysm from a simple haematoma, measure its size, identify the feeding neck, and assess any thrombus within. CT angiography may be used in selected cases for deeper or more complex lesions.

Treatment depends on size, location, and clinical context. Small lesions sometimes thrombose spontaneously and may simply be observed. Many groin pseudoaneurysms can be treated with ultrasound-guided compression or thrombin injection by an interventional team. Larger, infected, expanding, or symptomatic lesions usually require artery injury repair through open vascular surgery, with reconstruction tailored to preserve flow to the hand or leg and protect the underlying limb.

What to expect

• Detailed clinical assessment including history of recent procedures, anticoagulation, and dialysis access.
• Color Doppler ultrasound, and CT angiography where required, to characterise the lesion.
• Small or stable lesions may be managed with observation or ultrasound-guided techniques.
• Pseudoaneurysm surgery is offered for larger, expanding, infected, or symptomatic lesions.
• Coordinated follow-up with the dialysis or referring team protects long-term vascular access.

Recovery

• Avoid pressure or trauma at the site of the pseudoaneurysm during recovery.
• Adhere to wound care instructions and report bleeding or expanding swelling promptly.
• Anticoagulation may need temporary adjustment around any procedure.
• Long-term review helps identify recurrence or new vascular lesion treatment needs early.