Pseudoaneurysm

What is a pseudoaneurysm?

A pseudoaneurysm is a pooling of blood caused by injury to your blood vessel (usually your artery). It’s also called a false aneurysm.

Pseudoaneurysms are often complications from medical procedures like an angiogram. A pseudoaneurysm is localized. That means the blood leakage occurs in one specific location where your artery has been injured.

Some pseudoaneurysms are harmless and go away on their own. Others are more serious. If they rupture, they can cause serious complications or death. It’s important to know the causes and symptoms so you can seek medical help and prevent major problems.

What is the difference between pseudoaneurysm and aneurysm?

Pseudoaneurysms and aneurysms are bound by different types of “walls.” They also have different shapes.

Wall surrounding pseudoaneurysm vs. aneurysm

The main difference between a pseudoaneurysm and an aneurysm is the kind of material that surrounds it. This is known as the “wall” that contains the pseudoaneurysm or aneurysm.

An aneurysm is a bulge within your artery. That bulge still has all three layers of your artery wall (intima, media and adventitia) as its own wall.

On the other hand, a pseudoaneurysm only includes one or two layers of your artery wall. The rest of its wall is made of connective tissue that forms when your artery is injured. This wall is weaker than an aneurysm’s wall.

The pseudoaneurysm often has a narrow “neck” that connects it to your artery.

Shape of pseudoaneurysm vs. aneurysm

Aneurysms appear in different shapes and sizes. But they’re more likely than pseudoaneurysms to have a fusiform shape. This means the aneurysm is wider in the middle and gets narrower toward the endpoints. It looks a bit like a football stuffed into a long sock. It bulges out on all sides of your artery.

On the other hand, a pseudoaneurysm usually has an eccentric, sac-like shape. This means it’s rounder and sticks out from one side of your artery on its narrow neck. It doesn’t make your artery walls expand outward on all sides. Instead, it looks more like a balloon that bulges out from your artery wall.

What causes a pseudoaneurysm?

The cause of a pseudoaneurysm cause depends on its location in your body. Pseudoaneurysms are divided into different categories based on their location. Examples include femoral, visceral and aortic pseudoaneurysms.

Femoral pseudoaneurysms

This is the most common type. It occurs in an artery in your groin. Causes include:

• Complications from medical procedures, like a catheter inserted into an artery (most common).
• Trauma.
• Infection.

Visceral pseudoaneurysms

This type is rare. It occurs in an artery that supplies blood to your intestines, spleen or liver. Causes include:

• Complications from medical procedures or surgeries.
• Pancreatitis.

Aortic pseudoaneurysms

This type occurs in your largest artery (aorta). Causes include:

• Blunt trauma to your chest area.
• Infection.
• Complications from heart surgery.

People who have Marfan syndrome or Loeys-Dietz syndrome face a higher risk. These conditions weaken their blood vessel walls.

What are the symptoms of a pseudoaneurysm?

Symptoms of a pseudoaneurysm include:

• A painful or throbbing lump underneath your skin.
• Tenderness when you touch the area.
• Bruising or skin changes.
• Numbness or tingling (if the mass presses on your nerve).

How is a pseudoaneurysm diagnosed?

Your provider will discuss your symptoms and give you a physical exam. During the exam, your provider will check for:

• Swelling in your groin.
• A mass (or lump) under your skin.
• Tenderness at the site.
• Changes in skin color or texture that signal blood flow problems (skin necrosis).
• Turbulent blood flow (bruit, pronounced “broo-EE”).

Your provider may also perform a duplex ultrasound. This is a common method for checking blood flow in your arteries and veins. This painless test can check the size and location of the pseudoaneurysm.

What is the treatment for a pseudoaneurysm?

Treatment for a pseudoaneurysm depends on its location and size. Treatment options include observation, injections, compression and minimally invasive procedures. Surgery may be needed in rare cases when these methods don’t work. Your provider will discuss treatment options with you and decide which one is best for your situation.

Observation

Observation is suitable for a small femoral pseudoaneurysm (less than 2 centimeters in diameter). The problem may go away on its own within a few weeks. So your provider will simply keep a close eye on it. You’ll go in for a duplex ultrasound every week until the pseudoaneurysm clears up. You should avoid movements that may strain the area like lifting and bending.

Ultrasound-guided thrombin injection

A femoral pseudoaneurysm that’s bigger than 2 centimeters or causing much pain may need direct treatment. The most common method is called ultrasound-guided thrombin injection. Your provider will give you local anesthesia to keep you comfortable. Your provider will then inject an enzyme called thrombin into the pseudoaneurysm.

This procedure has a very high success rate. If it doesn’t solve the problem, you may need surgery. But this is rare.

Ultrasound-guided compression

In the past, providers used this method more often. However, research has shown it’s less successful than thrombin injections. It also has a higher risk of complications.

This method can be useful for very small femoral pseudoaneurysms (less than 1 centimeter in diameter). In those cases, injections may carry a higher risk of complications.

Minimally invasive procedures

Stents or small coils can be inserted to treat a visceral pseudoaneurysm. These devices stop blood from reaching the pseudoaneurysm and prevent complications.

An aortic pseudoaneurysm requires swift treatment to prevent a rupture. One life-saving measure is called endovascular aneurysm repair (EVAR). This procedure can fix the problem without the need for open-heart surgery.

How long does it take to recover from treatment for pseudoaneurysm?

Recovery depends on the type of treatment and your overall health condition. Your provider will guide your recovery and offer suggestions. You may need several hours of bed rest (lying flat) following a procedure. Your provider will watch you to make sure you don’t have any complications. You may also need to avoid driving or lifting heavy objects for a short time. But you’ll soon be able to return to your normal activities without any problems.

Depending on the procedure and your overall health, you may need follow-up appointments. For instance, if you have a stent, your provider needs to make sure it’s still working well. Your provider will also check for complications or infections. These routine visits are important and worth your time.

How can I reduce my risk of a pseudoaneurysm?

Some factors you can’t control, like your age. People over age 75 face a higher risk of a pseudoaneurysm. But you can manage some conditions that raise your risk, like obesity and hypertension (high blood pressure).

You can help prevent pseudoaneurysms and support your overall health by:

• Following a heart-healthy diet.
• Exercising regularly.
• Drinking plenty of water.
• Avoiding foods that are high in sodium (salt).
• Getting enough sleep.
• Managing stress.

What can I expect if I have a pseudoaneurysm?

A pseudoaneurysm can trigger serious problems if it ruptures. It can cause internal bleeding and could lead to death. But when caught early and treated, pseudoaneurysms are easily managed.

That’s why it’s important to be aware of the symptoms so you can quickly identify the problem and seek help. Pseudoaneurysms also can occur again in the future. So if you have one, it’s important to be aware of future symptoms. Keep your medical appointments and tell your provider about any symptoms or changes you notice.

When should I seek medical care?

Call your healthcare provider if you have any symptoms of a pseudoaneurysm or feel something isn’t right. Pay close attention if you recently had an endovascular procedure (a procedure with a catheter). Complications are rare. But it’s important to catch any if they do happen.

A pseudoaneurysm rupture is a medical emergency. Call 911 if you experience symptoms of a pseudoaneurysm rupture. These may include:

• Severe pain at the site of the lump.
• Chest pain.
• Shortness of breath.
• Confusion.
• Low blood pressure.
• Abnormal heart rate.

What questions should I ask my healthcare provider?

If you were just diagnosed with a pseudoaneurysm, you probably have lots of questions. Start by asking:

• What caused this pseudoaneurysm?
• How can I manage my symptoms?
• What treatment options are best for me?
• What will recovery look like for me?
• What activities should I avoid doing until my treatment?
• What activities should I avoid doing as I recover?

Your provider will work with you to make sure you're comfortable and have the information you need.

If you had a pseudoaneurysm in the past, talk with your healthcare provider about your future risks. Consider asking:

• Am I at risk of having another pseudoaneurysm?
• Do I have any other medical conditions that affect my risk?
• What can I do to lower my risk?

If you’ve never had any problems, you can still talk with your provider to learn more. Ask about any risk factors you might have and learn how to reduce your risk of future problems.

If you have a catheter-based procedure coming up, talk with your provider about the risks. Pseudoaneurysms usually are complications from such procedures. But that doesn’t mean they’re common. In fact, only about 1 in 200 people have this issue after an angiogram. The benefits of these procedures outweigh the risks. It’s still important to talk with your provider to get all your questions answered.

A note from Cleveland Clinic

Learning you have a pseudoaneurysm can be scary and unexpected. But thanks to new treatments and technologies, you can recover and carry on with life as normal. The key is getting diagnosed early when symptoms first start. It’s also important to know your risks for a pseudoaneurysm. Complications from medical procedures like angiograms are the most common cause. But personal risk factors like obesity and hypertension can also play a role. Talk with your provider to learn more about your risks and how to manage them.