Aortic Pseudoaneurysms

Abstract

Aortic pseudoaneurysms are blood-filled cavities formed between the two outer layers of the vessel, the muscularis propria and adventitia. The dilated segment of the aorta of the pseudoaneurysm is lined only by the adventitia which distinguishes pseudoaneurysms from true aneurysms in which all three layers of the vessel wall are involved. Pseudoaneurysms can occur after injury to the vessel, and most cases arise due to prior aortic or cardiac surgery. Other causes leading to impairment in the integrity of the vessel wall can be blunt trauma, percutaneous surgical procedures, autoimmune diseases, inflammation, and mycotic pseudoaneurysms secondary to tuberculosis (Quevedo HC, Santiago-Trinidad R, Castellanos J, Atianzar K, Anwar A, Abi Rafeh N, Ochsner J 14:576–85, 2014). Complications of pseudoaneurysms are unpredictable, and they have the potential to create life-threatening conditions. Therefore, early diagnosis and treatment is essential to maximize survival. Even though endovascular techniques to repair aortic pseudoaneurysms are emerging, open surgery plays an important role and still counts as the standard treatment (Duraes A, Schonhofen I, Freitas C, Bitar Y, J Gen Emerg Med 2(5); Malvindi PG, van Putte BP, Heijmen RH, Schepens MA, Morshuis WJ Ann Thorac Surg 90(5):1437–43, 2010). Endovascular repair methods are limited to high-risk surgical patients, but these methods including stent grafts, coil embolization (Fann JI, Samuels S, Slonim S, Burdon TA, Dalman RL, J Vasc Surg 35:811-4, 2002), thrombin injections (Lin PH, Bush RL, Tong FC, Chaikof E, Martin LG, Lumsden AB, J Vasc Surg 34:939-42, 2001), septal occluder devices (Stabenow L, Byers M, Malik A, Ali F, Vasc Dis Manag 15:E39-E41, 2018), and vascular plugs become more and more popular.