Iatrogenic pseudoaneurysms – Ultrasonographic evaluation

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Ileana Arsenescu

Article received on the 13th August 2012. Article accepted on the 27th August 2012.

„Prof. Dr. C. C. Iliescu“ Emergency Institute for Cardiovascular Diseases, Bucharest

Dr. Ileana Arsenescu, „Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest

Pseudoaneurysms represent one of the relatively freq­uent complications of interventional procedures, especially after therapeutic maneuvers.
The clinical diagnosis is based on the development of a pulsating formation at the puncture site, presenting a con­tinuous murmur.
Ultrasonographic diagnosis:
– pseudoaneurysm appears as a well defined cavity whose content is initially anechogenic (Figure 1). The shape and dimensions vary from one case to another, with the possibility of multiple si­mul­­ta­neous pseudoaneurysms. The initial color Do­ppler examination shows the red-blue filling pha­se, typical for aneurysms (Figure 2). The spectral Do­ppler correspondent for this aspect is the low speed dual phase signal (Figure 3). Most false aneu­r­ysms evolve towards thrombosis, develop­ing echogenic, nonhomogeneous content and loss of its Doppler signal.

Figure 1. Post-coronarography inguinal pseudoaneurysm. The aspect is of a well-defined formation, with the predominance of anechogenic content. Discreet spontaneous contrast near the posterior wall.

Figure 2. The Doppler color examination shows the bicolor filling, with a clear delimitation between the red and the blue zone.

Figure 3. The Doppler signal in the aneurysm is dual phase, with low speeds.

– The communication with the artery usually has a si­nuous trajectory, where a dual phase systolic si­g­nal is registered. During the systole the blood flows from the high pressure artery towards the low pressure pseudoaneurysm. During the diastole the pressure is higher in the pseudoaneurysm, whi­ch leads to a large back-flow to the artery (Figure 4 and 5).

Figure 4. Diagram showing the mechanism generating the Doppler signal from the pseudoaneurysm supply path.

Figure 5. The Doppler signal in the communication between the femoral ar­te­ry and the aneurysm (S = systole, D = diastole).

– The Doppler signal is usually normal in the artery supplying the blood for the pseudoaneurysm.

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