Authors
Chernyavin M.P.1, Petrov K.Yu.1, Kemov S.Sh.2, Belov Yu.V.3, 4
1 Chief military clinical hospital named after academic N.N. Burdenko, Moscow
2 North Caucasian State Academy, Cherkessk
3 Petrovsky National Research Centre of Surgery, Moscow
4 I.M. Sechenov First Moscow State Medical University, Moscow
Abstract
False peripheral aneurysms represent a significant challenge in vascular surgery, as they can remain subclinical for extended periods and manifest only at the stage of complications, including rupture and thrombosis. Unlike true aneurysms, which involve a protrusion of the blood vessel wall, a pseudoaneurysm does not involve damage to the entire wall structure. Instead, blood escapes from the site of injury and is contained by a wall formed from the surrounding tissues. Timely diagnosis and treatment of false aneurysms are essential. All patients with penetrating limb injuries should undergo routine ultrasound duplex scanning (USDS). In elective cases with suspected false aneurysm and no significant hematoma, MSCT angiography is indicated. In the presence of a hematoma or signs of active bleeding, urgent selective angiography is required to determine the subsequent treatment strategy.
Conclusion. Post-traumatic false peripheral aneurysms pose a serious threat due to the risk of rupture and thrombosis. The key diagnostic algorithm includes: routine vascular USDS for all patients with limb injuries, MSCT angiography for elective cases without hematoma, and selective angiography in cases of active bleeding. Timely imaging prevents long-term complications and dictates the optimal management strategy.
Keywords: рseudoaneurysm, false aneurysm, traumatic vascular injury, vascular wall pathophysiology, risk factors, diagnostic algorithm, diagnostic imaging, duplex ultrasound, multidetector computed tomography (MDCT), CT angiography, conventional angiography, pulsating hematoma, vascular surgery.
References
1. Sokhal BS, Ma Y, Rajagopalan S. Femoral artery aneurysms. Br J Hosp Med (Lond). 2022; 83(12): 1-10. doi:10.12968/hmed.2022.0258.
2. Sarioglu O, Capar AE, Belet U. Interventional treatment options in pseudoaneurysms: different techniques in different localizations. Pol J Radiol. 2019; 84: e319-e327. doi: 10.5114/pjr.2019.88021.
3. Dorn A, Galkin P, Kalmykov E, Majd P. A clinical case of massive pseudoaneurysm of the anterior tibial artery. Russian Medical and Biological Bulletin named after academician I.P. Pavlov. 2021; 29(2): 293-298. doi: 10.17816/PAVLOVJ70498.
4. Wang Y, Zheng H, Yao W, et al. Management of traumatic peripheral artery pseudoaneurysm: A 10-year experience at a single center. J Interv Med. 2022; 6(1): 29-34. doi: 10.1016/j.jimed.2022.10.002.
5. Stone PA, Martinez M, Thompson SN, et al. Ten-Year Experience of Vascular Surgeon Management of Iatrogenic Pseudoaneurysms: Do Anticoagulant and/or Antiplatelet Medications Matter? Ann Vasc Surg. 2016; 30: 45-51. doi: 10.1016/j.avsg.2015.06.068.
6. Dwivedi K, Regi JM, Cleveland TJ, et al. Long-Term Evaluation of Percutaneous Groin Access for EVAR. Cardiovasc Intervent Radiol. 2019; 42(1): 28-33. doi: 10.1007/s00270-018-2072-3.
7. Rivera PA, Dattilo JB. Pseudoaneurysm. 2024 Feb 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
8. Lysenko AV, Belov YuV, Katkov AI, Komarov RN, Stonogin AV. Surgical treatment of false aneurysm of internal carotid artery after carotid endarterectomy. Pirogov Russian Journal of Surgery. 2016; 7: 80‑84. (In Russ.) doi: 10.17116/hirurgia2016780-84.
9. Tenishev RR, Kazantsev AN, Belyai ZhM, et al. Results of surgical treatment of patients with false aneurysms of peripheral arteries in a military field hospital of the special military operation zone. Russian Journal of Cardiology. 2025; 30(10S): 6577. (In Russ.) doi: 10.15829/ 15604071-2025-6477.
10. Raherinantenaina F, Rajaonanahary TMA, Rakoto RHN. Management of traumatic arterial pseudoaneurysms as a result of limb trauma. Formosan Journal of Surgery. 2016; 49(3): 89-100. doi: 10.1016/j.fjs.2016.04.001.
11. Belyakin SA, Pinchuk OV, Obraztsov AV, Yamenskoy VV. Diagnosis and Treatment of Peripheral Arterial Aneurysms of the Lower Extremities. Military Medical Journal. 2014; 335(7): 24-27. (In Russ.) doi: 10.17816/RMMJ74214.
12. Popovic B, Freysz L, Chometon F, et al. Femoral pseudoaneurysms and current cardiac catheterization: evaluation of risk factors and treatment. Int J Cardiol. 2010; 141(1): 75-80. doi: 10.1016/j.ijcard.2008.11.111.
13. Azizzadeh A, Keyhani K, Miller CC 3rd, Coogan SM, Safi HJ, Estrera AL. Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg. 2009; 49(6): 1403-8. doi: 10.1016/j.jvs.2009.02.234.
14. Moreno Real D, de Araújo Martins-Romêo D. Imaging of pseudoaneurysms: Key diagnostic findings, causes and complications. Radiologia (Engl Ed). 2025; 67(2): 202-213. doi: 10.1016/j.rxeng.2024.07.002.
15. Goksu E, Yuruktumen A, Kaya H. Traumatic pseudoaneurysm and arteriovenous fistula detected by bedside ultrasound. J Emerg Med. 2014; 46(5): 667-9. doi: 10.1016/j.jemermed.2013.08.136.
16. Miller-Thomas MM, West OC, Cohen AM. Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls. Radiographics. 2005; 25S1: S133-42. doi: 10.1148/rg.25si055511.
17. Zizi O, Naouli H, Jiber H, Bouarhroum A. Fistule artérioveineuse poplitée post-traumatique associée à un faux anévrysme. J Med Vasc. 2017; 42(1): 46-49. doi: 10.1016/j.jdmv.2017.01.006.
18. Kent KC, McArdle CR, Kennedy B, et al. Accuracy of clinical examination in the evaluation of femoral false aneurysm and arteriovenous fistula. Cardiovasc Surg. 1993; 1(5): 504-7.
19. Leshchinskaya OV, Kudryashova NE, Mikhailov IP, et al. Posttraumatic False Femoral Artery Aneurysm with Arteriovenous Anastomosis in a 32-Year-Old Patient (Clinical Case). Sklifosovsky Journal of Emergency Medical Care. 2019; 8(4): 458-462. (In Russ.) doi: 10.23934/2223-9022-2019-8-4-458-462.
20. Davison BD, Polak JF. Arterial injuries: a sonographic approach. Radiol Clin North Am. 2004; 42(2): 383-96. doi: 10.1016/j.rcl.2004.01.007.
21. Fry WR, Smith RS, Sayers DV, et al. The success of duplex ultrasonographic scanning in diagnosis of extremity vascular proximity trauma. Arch Surg. 1993; 128(12): 1368-72. doi: 10.1001/archsurg.1993.01420240076015.
22. Corvino A, Catalano O, de Magistris G, et al. Usefulness of doppler techniques in the diagnosis of peripheral iatrogenic pseudoaneurysms secondary to minimally invasive interventional and surgical procedures: imaging findings and diagnostic performance study. J Ultrasound. 2020; 23(4): 563-573. doi: 10.1007/s40477-020-00475-6.
23. Jens S, Kerstens MK, Legemate DA, et al. Diagnostic performance of computed tomography angiography in peripheral arterial injury due to trauma: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2013; 46(3): 329-37. doi: 10.1016/j.ejvs.2013.04.034.
