Arunagiri, V (2012) Evaluating aetiologies, treatment strategies and optimizing outcomes in pseudoaneurysms. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: A pseudoaneurysm (false aneurysm) by definition results from a leakage of blood from an artery after trauma or after dehiscence of a surgical anastomosis. There are various etiologies for pseudoaneurysms like post anastomotic, post traumatic, infective, iatrogenic and idiopathic. We would like to discuss the various spectrums of pseudoaneurysms that had presented to our department, their clinical presentation and management strategies. PATIENTS AND METHODS: This study was conducted in the Department of Vascular surgery from August 2009 to January 2012. This was a descriptive study about patients presenting with pseudoaneurysms to the Vascular surgery Out Patient Department and Surgical emergency. Both elective and emergency cases were enrolled. The elective patients were evaluated with clinical examination, Duplex USG and 64 slice CT angiography in selected patients. Routine blood investigations with blood culture and clot or wall culture were performed. All the emergency cases were evaluated with clinical examination and if hemodynamically stable were subjected to Duplex examination. Once the diagnosis was confirmed, the patients were subjected to surgical intervention or duplex guided compression. RESULTS: There were totally 50 patients. Among the 50 patients, 15(30%) had anastomotic and 12 (24%) had posttraumatic pseudoaneurysms. The rest were infective 4 (8%), iatrogenic 6 (12%), idiopathic 2 (4%) and AV access related 11 (22%) pseudoaneurysms. Anastomotic and post traumatic comprised of more than half (54%) of patients. Skin breach was found in 22 (44%), active bleeding in 15 (30%), impending rupture in 15 (30%) and distal ischemia in 4 (8%). 36 (72%) patients presented as an emergency. Rest 14 (28%) patients presented in an elective manner. 4%) patients were subjected to Duplex guided compression. 23 (46%) underwent reconstruction and 25 (50%) underwent ligation with explantation of the graft. There were 3 (6%) deaths among the 50 patients. 6 (14%) patients underwent amputation and the rest 37 (86%) patients limbs were salvaged. There was a higher risk of limb loss in patients presenting with anastomotic aneurysms especially operated for occlusive arterial disease.(P=0.048) Out of the 11 patients with AV access related pseudoaneurysms, AVF salvage was achieved only in two patients (18%). CONCLUSION: Overall, Anastomotic pseudoaneurysms had a poorer prognosis in terms of increased amputation rates and lower limb salvage rates. This was because of distal occlusive disease and poor collateralisation.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Evaluating aetiologies, treatment strategies, optimizing outcomes, pseudoaneurysms. |
| Subjects: | MEDICAL > Vascular Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 20 Feb 2020 01:00 |
| Last Modified: | 20 Feb 2020 01:00 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11965 |
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