Pseudoaneurysm

A pseudoaneurysm (also called a false aneurysm) is contained bleeding from an injury to your artery. It looks like a round bulge that sticks out from one side of your artery. The blood collects within a “wall” that keeps it from leaking into nearby tissues.

You might wonder what’s “pseudo,” or false, about this condition. A pseudoaneurysm is very real — and it can be serious if its wall ruptures. But it’s “false” in the sense that it doesn’t involve all three layers of your artery wall. A “true” aneurysm involves all three layers. Those layers, together, serve as the aneurysm’s wall.

A pseudoaneurysm, on the other hand, only uses one or two layers of your artery wall for its own wall. The rest of its wall is made of tissue that forms when the artery is injured. Its wall is weaker than an aneurysm’s wall.

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

Types of pseudoaneurysms

Healthcare providers divide these false aneurysms into different types based on their location. Here are some examples:

• Femoral pseudoaneurysms: This is the most common type. It affects your femoral artery, which is in your groin. It usually occurs as a complication of a medical procedure, like an angiogram, that involves putting a catheter into your artery. (Still, it’s a rare complication.)
• Aortic pseudoaneurysms: This type occurs in a large artery called your aorta. Causes include blunt trauma to your chest, infections and complications from heart surgery.
• Visceral pseudoaneurysms: This type is very rare. It occurs in an artery that supplies blood to internal organs like your intestines, spleen or liver. Causes include pancreatitis and complications from medical procedures.
• Left ventricular pseudoaneurysms: While most pseudoaneurysms form in arteries, this type forms in your heart. It’s a rare complication of a heart attack. Heart muscle ruptures, causing blood to pool between your heart’s outer wall and the sac that surrounds it.

Symptoms of a false aneurysm

Pseudoaneurysm symptoms include:

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

Symptoms of left ventricular and aortic pseudoaneurysms are different. They include:

• Chest pain
• Shortness of breath
• Irregular heartbeat
• Symptoms of heart failure

Pseudoaneurysm causes

Pseudoaneurysms can develop if there’s damage to an artery. The most common causes of such damage include:

• Complications from surgeries or catheter-based procedures
• Traumatic injury
• Pancreatitis (for visceral pseudoaneurysms)

Injuries to your arteries can also cause hematomas. But a hematoma is a pooling of blood that doesn’t have walls around it, as a pseudoaneurysm does. Think of a hematoma like a bruise.

Complications of this condition

Without treatment, this can lead to:

• Nerve pain
• Deep vein thrombosis (DVT)
• Gangrene
• Rupture and internal bleeding

Some pseudoaneurysms — especially those that form in your heart — can be fatal. Early diagnosis and treatment can be lifesaving.

How doctors diagnose pseudoaneurysms

Your provider will discuss your symptoms and give you a physical exam. The size and location of the pseudoaneurysm determine what they look for and the tests they use.

For example, if your provider suspects a femoral pseudoaneurysm, they’ll check for:

• Swelling in the affected area
• A lump under your skin
• Tenderness at the site
• Changes in skin color or texture that signal blood flow problems
• Turbulent blood flow (bruit, pronounced “broo-EE”) that your provider can hear through a stethoscope

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 also check the size and location of the pseudoaneurysm.

If your provider suspects a left ventricular or aortic pseudoaneurysm, they’ll do imaging tests. These help your provider see any issues. Possible tests include:

• Chest X-ray
• Echocardiogram
• Heart CT scan

How is a pseudoaneurysm treated?

Treatment for a pseudoaneurysm depends on its location and size. Options include:

• Observation: This means your provider keeps a close eye on the situation. Observation may be suitable for a small femoral pseudoaneurysm. The problem may go away on its own within a few weeks. If it doesn’t go away, you’ll need treatment.
• Ultrasound-guided thrombin injection: Your provider injects a substance called thrombin into the pseudoaneurysm. This causes the pooled blood to clot (and stay there), taking care of the problem. Your provider uses ultrasound to confirm the injection worked.
• Ultrasound-guided compression: Your provider puts pressure on the pseudoaneurysm to stop blood from flowing into it. They may put a compression bandage on the area and/or use a device to apply pressure on your skin. They use ultrasound to view the process.
• Surgery: For femoral pseudoaneurysms, surgery is a last resort if other treatments don’t work. Surgery is often a first-choice treatment for visceral, aortic and left ventricular pseudoaneurysms.

Your provider will tell you which treatment is best for your case. They’ll also explain the benefits and risks.

When should I see my healthcare provider?

Call your healthcare provider if:

• You have any symptoms of a pseudoaneurysm or feel something isn’t right
• You recently had an endovascular procedure (a procedure with a catheter) and develop worsening pain, lightheadedness/dizziness or significant swelling in the area

Call 911 (or your local emergency service number) if you have a known pseudoaneurysm and develop sudden, significant pain in your chest, back or abdomen.

What can I expect if I have this condition?

A pseudoaneurysm is dangerous if it ruptures. It can cause internal bleeding and, possibly, death. But when caught early and treated, pseudoaneurysms are easily manageable. You may need follow-up visits with your provider after treatment.