Arterial false aneurysms and their modern management

Background: Both diagnostic and therapeutic options in the management of ia trogenic false aneurysms have changed dramtically in the last decade, with surgery being required only rarely. Objective: To describe our experience, techniques and results in treating p seudoaneurysms at a large medical center with frequent arterial interventio ns. We emphasize upper limb lesions. Materials and Methods: We reviewed the data of all consecutive patients dia gnosed by color-coded duplex Doppler between August 1992 and July 1998 as h aving upper limb and lower limb pseudoaneurysms (mainly post-catheterizatio n). We accumulated 107 false aneurysms (mainly post-catheterization lesions ): 5 were upper limb lesions and 102 were groin aneurysms. Results: In the lower limb cases 94 of the 102 lesions were not operated up on (92.1%). Seventy lower limb cases were treated non-operatively by ultras ound-guided compression obliteration with a 95.7% success rate (67 cases). Two cases were treated by percutaneous thrombin injection (2%) and 23 by ob servation only (22.5%). Altogether 12 patients underwent surgery (11.2%): 4 upper extremity acid 8 lower extremity cases, None of the lower limb group suffered serious complications regardless of treatment, but all five upper limb cases did, four of them necessitating surgical intervention. Three of the five upper limb cases had a grave outcome with severe or permanent fun ctional or neurological damage. Conclusion: Most post-catheterization pseudoaneurysms can be managed non-su rgically. False aneurysms in the upper extremity are rare, comprising less than 2% of all lesions, However, upper extremity pseudoaneurysms present a potentially more serious complication and require early diagnosis and promp t intervention to minimize the high complication rate and serious long-term sequelae. Prevention can be achieved by proper puncture technique and site selection, and correct post-procedure hemostatic compression with or witho ut an external device. Some upper limb lesions are avoidable if the axillar y artery is not punctured.