[Management of pseudoaneurysm associated with endovascular treatments at third level].

Abstract

Background: Pseudoaneurysms occur when the wall of a blood vessel is injured and the leaking blood accumulates in the surrounding tissue, with a prevalence of 0.5-2%. Their etiology is mainly associated with arterial puncture, needle and introducer size, use of ultrasound (US), duration or complexity of the procedure, as well as the use of anticoagulation and closure devices. Risk factors include age ≥75 years, female sex, chronic kidney disease, systemic arterial hypertension (SAH), type 2 diabetes mellitus (T2DM), cardiac arrhythmia, infected tissues, and multiple puncture attempts.

Objective: To analyze management protocols for pseudoaneurysms secondary to endovascular procedures in a tertiary care unit in western Mexico.

Materials and methods: Analytical cross-sectional study with a longitudinal component. Electronic medical records and US reports with a diagnosis of pseudoaneurysm in patients undergoing endovascular procedures were reviewed from January 1 to December 31, 2022. A p value ≤ 0.05 was considered statistically significant.

Results: Forty-eight patients were evaluated: Group 1 (conservative treatment, n = 27) and Group 2 (invasive treatment, n = 21). Group 2 vs. Group 1: mean age (62.67 ± 16.93 vs. 66.48 ± 11; p = 0.018). Procedures included cardiac catheterization, peripheral angioplasty, and transcatheter aortic valve implantation (TAVI). Time (days) to referral for evaluation (158 ± 34.4 vs. 6.86 ± 1.32; p = 0.032); femoral access (62% vs. 52%; p = 0.125); sac size ≥3 cm (81% vs. 22%; p = 0.001).

Conclusions: Fifty-six percent resolved with conservative management and 44% required invasive treatment. Associated factors were sac diameter ≥3 cm and ≥30 days to request angiologic evaluation.