Post-Traumatic Intracranial Pseudoaneurysm Presenting as Epistaxis

Background

Epistaxis is a frequent presenting complaint in the Emergency Department (ED). Roughly 60% of the population will suffer from epistaxis in their lifetime. The most common causes of epistaxis include nose picking, facial trauma, foreign bodies, and coagulopathies. There are other causes that are much less common, such as intracranial pseudoaneurysms. There are multiple causes that precipitate intracranial pseudoaneurysm formation, with head trauma accounting for less than 1% of inciting events.

Case Report

A 24-year-old female with history of traumatic brain injury with associated skull fractures due to a gunshot wound to the head 6 months prior presented to the ED in hemorrhagic shock secondary to epistaxis. After stabilization with the administration of blood products, Computed Tomography with Angiography (CTA) imaging of the head and neck was obtained and revealed a 3.1 × 2.2 × 2.5 cm pseudoaneurysm of the cavernous portion of the right internal carotid artery penetrating through the base of the skull into the ethmoidal sinus. The patient was taken for formal angiography by interventional radiology-and a partially thrombosed daughter sac of the initial aneurysm was identified and believed to be the source of the hemorrhage. The aneurysm was successfully coiled and occluded using ONYX embolization. Postoperatively, the patient returned to her baseline mental status without any acute complaints. The patient was discharged back to her nursing home 2 days later with a 3-week follow-up CTA revealing persistent occlusion of the aneurysm and a patent internal carotid artery.

Conclusion

Awareness and consideration of intracranial vascular etiology for common complaints in the emergency room, such as Epistaxis, especially in patients with any history of head injury/trauma, known intracranial aneurysms or prosthetic devices from prior surgery may help guide decision-making in managing critically ill patients.

Successful coil embolization of a ruptured pseudoaneurysm of the superior gluteal artery after a percutaneous awake robot-assisted sacroiliac joint fusion: illustrative case

BACKGROUND

Robot-assisted sacroiliac joint (SIJ) fusion has gained popularity, but it carries the risk of complications such as injury to the superior gluteal artery (SGA). The authors present the case of an awake percutaneous robot-assisted SIJ fusion leading to an SGA pseudoaneurysm.

OBSERVATIONS

An 80-year-old male, who had undergone an awake percutaneous robot-assisted SIJ fusion, experienced postoperative left hip pain and bruising. Subsequent arteriography demonstrated an SGA branch pseudoaneurysm requiring coil embolization.

LESSONS

An SGA injury, although uncommon (1.2% incidence), can arise from percutaneous screw placement, aberrant anatomy, or hardware contact. Thorough preoperative imaging, precise robot-assisted screw insertion, and soft tissue protection are crucial to mitigate risks. Immediate angiography aids in prompt diagnosis and effective intervention. Comprehensive knowledge of anatomical variants is essential for managing complications and optimizing preventative measures in robot-assisted SIJ fusion.

Hepatic artery aneurysms in infective endocarditis: report of 10 cases and literature review

BACKGROUND

Hepatic artery aneurysms (HAAs), albeit rare in infective endocarditis (IE), are associated with a life-threatening morbidity.

METHODS

Retrospective review of 10 HAA-IE-patients based on a total of 623 IE-patients managed in two institutions (2008-2020) vs 35 literature' cases.

RESULTS

In our patient population, HAAs (10 males, mean-age 48) were incidentally found during IE-workup. All were asymptomatic. IE involved mitral (n=6), aortic (n=3), or mitral-aortic valve (n=1). Predisposing factors for IE were: prosthetic valve (n= 6), previous IE (n=2), IV drug user (n=1). Streptococcus spp were predominant (n=4), then staphylococcus spp (n=2) and E. faecalis (n=2). All patients presented associated lesions: infectious aneurysms (n=5), emboli (n=9), abscesses (n=5) and spondylitis/spondylodiscitis (n=2). HAA patterns on abdominal CT-Angiography (CTA) were solitary (70%), mean diameter 11.7mm (range 2-30), intrahepatic location (100%) involving the right HA in 9/10 (90%) patients. In 2 patients HAAs were complicated (rectorragia and hemobilia in 1, cholestasis in the other). Six patients underwent endovascular hepatic embolization (2 with multiple HAAs). Three HAA-IEs <15mm resolved under antibiotherapy on abdominal CTA follow-up. All patients underwent cardiac surgery. Late outcome was favorable in all followed patients (5/10). Literature review showed the preponderance of Streptococcus spp., of right lobe and intrahepatic HAA localization. Complications revealed HAAs in patients under antibiotic therapy and/or after cardiac surgery in 17 literature' cases of delayed diagnosis.

CONCLUSION

Abdominal CTA was pivotal in the initial IE work-up. Small aneurysms (≤15mm) resolved under antibiotherapy. The usual treatment modality was HAA embolization and endovascular embolization prior to valve surgery was safe.

Relaparotomy pseudoaneurysm repair after distal pancreatectomy with celiac axis resection (DP-CAR): a case report

A 76-year-old man underwent distal pancreatectomy with celiac axis resection (DP-CAR) after preoperative chemotherapy for pancreatic cancer with celiac artery invasion. Although postoperative pancreatic leakage and ischemia-induced bile fistula developed, the patient's condition remained stable with good drainage. On postoperative Day 47, a pseudoaneurysm developed at the junction of the gastroduodenal artery and proper hepatic artery. However, cannulation of the guidewire was difficult, and relaparotomy pseudoaneurysm repair was performed. On postoperative Day 56, a pseudoaneurysm reappeared at the same site, and relaparotomy was performed again. On postoperative Day 61, CT confirmed the disappearance of the pseudoaneurysm and preservation of the right and left hepatic arteries. The patient was discharged 107 days postoperatively. Interventional radiology (IVR) remains the best technique to achieve hemostasis for pseudoaneurysms. However, this case demonstrates that even when hemostasis by IVR is difficult, relaparotomy pseudoaneurysm repair after DP-CAR may be useful after some postoperative.

Successful treatment of a large profunda femoris artery aneurysm and associated pseudoaneurysm using endovascular stenting

Profunda femoris artery aneurysms are a rare form of peripheral arterial aneurysm. In this report, we present the case of an 83-year-old lady who was found to have a 65 mm aneurysm arising from the proximal left profunda femoris artery and associated pseudoaneurysm. Successful treatment was achieved using an endovascular approach in which two stents were deployed.

Giant 20 × 35 cm brachial artery pseudoaneurysm after fistulogram treated with surgical resection of pseudoaneurysm and patch angioplasty of brachial artery

Brachial artery pseudoaneurysms are a rare entity, which can occur secondary to infectious, traumatic, or iatrogenic causes. We present a 78-year-old female with end-stage renal disease on hemodialysis via a right brachio-basilic arteriovenous fistula. She had previously undergone numerous fistulograms and endovascular interventions for right upper extremity swelling due to prolonged bleeding following dialysis. After a recent fistulogram she developed recurrent arm swelling. Duplex showed a large hematoma without any evidence of vascular flow. However, intraoperatively, she was noted to have a giant 20 × 35 cm pseudoaneurysm of the brachial artery. Therapeutic options include endovascular stenting, embolization, thrombin injection, ultrasound-guided compression, and surgery. We elected to perform resection of the large pseudoaneurysm and arteriovenous fistula ligation due to the large size. Given her end-stage renal disease status and lacking quality autogenous vein, we were able to perform a patch angioplasty repair of her brachial artery without requiring a bypass.

A review of histopathologic and radiologic features of non-atherosclerotic pathologies of the extracranial carotid arteries

Diseases of the carotid arteries can be classified into different categories based on their origin. Atherosclerotic carotid disease remains the most encountered arterial wall pathology. However, other less-common non-atherosclerotic diseases can have detrimental clinical consequences if not appropriately recognized. The underlying histological features of each disease process may result in imaging findings that possess features that are obvious of the disease. However, some carotid disease processes may have histological characteristics that manifest as non-specific radiologic findings. The purpose of this manuscript is to review various non-atherosclerotic causes of carotid artery disease as well as their histologic-radiologic characteristics to aid in the appropriate recognition of these less-commonly encountered pathologies.

Delayed development of a huge chest wall hematoma post pacemaker implantation: A case report

An 83-year-old Chinese man presented with a huge left chest wall hematoma and hemorrhagic shock 4 months after permanent pacemaker implantation. Computed Tomography of Angiogram of the left subclavian artery revealed a pseudoaneurysm. He underwent radiologically guided stenting followed by hematoma clearance. It is rare to have delayed formation of pseudoaneurysm at 4 months post pacemaker implantation. Radiologically guided stenting is the preferred treatment, followed by hematoma clearance. It is strongly advised against blind surgery for wound debridement or bleeding detection. Familiarizing with axillary vein anatomy, improving axillary vein cannulation skills, and detecting early complications of artery injury are key strategies in preventing pseudoaneurysm formation post pacemaker implantation.

Treating Femoral Artery Pseudoaneurysm by Tumescence Anesthesia and Echo-Guided Compression Technique (TACT): Clinical Outcome in 82 Consecutive Patients

PURPOSE

Pseudoaneurysm (PA) of the access artery is a common and potentially severe complication after percutaneous endovascular interventions. Most PA require interventional therapy, including thrombin injection, covered stent implantation, or surgical repair, which are costly and associated with other complications. Treating PA by external compression is uncomfortable and time consuming, with a low success rate. By injecting local tumescence anesthesia around the PA and close to its neck, the tumescence anesthesia and echo-guided compression technique (TACT) aims to improve efficacy and patient's comfort.

MATERIALS AND METHODS

We retrospectively reviewed all consecutive patients treated for femoral PA in our center from May 2009 to July 2019 and estimated efficacy and safety. Vascular specialists performed TACT according to a standardized protocol including ultrasound-guided injection of tumescence solution (45 ml of 0.9% saline, 15 ml of lidocaine 1%/epinephrine 5 μg/ml) in the soft tissue around the PA and its neck, local compression with the sonography probe until PA closure, and external compression by elastic belt for 3 hours.

RESULTS

Among a total of 125 patients with femoral artery PA, 82 (65.6%) were treated by TACT (including 3 patients with haemorrhagic shock), 14 (11.2%) by thrombin injection; 12 (9.6%) by endovascular interventions; 8 (6.4%) by open surgery; and 9 (7.2%) conservatively. In patients treated by TACT, PA neck was short (<1 cm) in 51.8% and mean cavity diameter 30 ± 23 mm. After injection of 58 ± 8 ml of tumescence solution, mean time of echo-guided compression was 12 ± 8 minutes. Pseudoaneurysm was successfully closed in 92.7% after the first attempt and in 96.3% after the second attempt. The intervention was well tolerated, without any adverse event.

CONCLUSION

Tumescence anesthesia and echo-guided compression technique (TACT) is an effective and safe treatment for PA. Compared to other therapies, TACT is minimally invasive and widely available for minimal costs, even for large PA and in unstable patients.

CLINICAL IMPACT

Tumescence anesthesia and echo-guided compression technique seems to be an efficient, safe, and a fair economical choice in comparison with alternative techniques. The implementation of this procedure is simple with low risk of complications. Based on the results of this study, we believe that TACT should be considered as the first-line treatment of most iatrogenic PA.

Post-traumatic jejunal branch of superior mesenteric artery pseudoaneurysm in paediatrics: a compelling case report highlighting early diagnosis and successful endovascular embolization

Introduction and importance

This manuscript underscores the critical significance of prompt diagnosis and intervention in cases of post-traumatic gastroduodenal artery pseudoaneurysms. Such occurrences, particularly in the paediatric population, are rare but potentially life-threatening complications following abdominal trauma, necessitating heightened clinical awareness. Despite their rarity, the devastating consequences of delayed recognition and management emphasize the necessity for advanced imaging modalities and individualized treatment strategies.

Case presentation

A 17-year-old male presented with severe epigastric pain following a football fall. Despite initial stability, persistent symptoms prompted further investigation. Conventional screening methods proved inconclusive, leading to a contrast-enhanced computed tomography (CT) scan that revealed a jejunal branch of superior mesenteric artery (SMA) pseudoaneurysm. The subsequent fluoroscopy-guided angiography and successful embolization using glue exemplify the importance of timely intervention in such cases.

Conclusion

This case highlights the importance of early recognition and appropriate intervention in post-traumatic jejunal branch of SMA pseudoaneurysms. The successful outcome achieved through endovascular embolization underscores the necessity for vigilant monitoring and tailored management strategies in similar clinical scenarios.

Open repair of transverse cervical pseudoaneurysm

A 40-year-old woman was referred to the vascular surgery clinic complaining of right shoulder pain and swelling secondary to blunt trauma 4 months ago. Computed tomography angiography showed a partially thrombosed supraclavicular pseudoaneurysm adjacent to the subclavian artery measuring 4.5 × 4 × 3.1 cm. Open repair surgery with resection of the pseudoaneurysm was successfully performed without injury to the capsule. Patient was stable and discharged 2 days later with no complications.

A Hybrid Approach That May Facilitate the Repair of Traumatic Popliteal Artery Pseudoaneurysms

PURPOSE

Traumatic popliteal pseudoaneurysms may occur in accidents or as an iatrogenic complication of a total knee arthroplasty. Complications often arise in open repair because of distorted anatomy. Up to 22% of the patients may suffer above-knee amputation. Endovascular treatment has proven to be an effective solution. However, the long-term performance of stents at the hinge point of the popliteal artery is questionable. We present a hybrid technique that was used successfully in 2 cases.

TECHNIQUE

Our approach takes advantage of both open and endovascular techniques. At first, we apply a stent graft at the side of the injury to cover the arterial trauma and stop blood leakage to the aneurysm sac. This allows for a safer dissection and open repair. We clamp the artery proximally and distally, open the sac, extract the stent graft, and extend to a longitudinal arteriotomy. We then reconstruct the entire area with a standard in lay end-to-end anastomosis using a vein graft. This hybrid technique may reduce the risk of uncontrollable bleeding and allow for a safer nerve decompression.

CONCLUSIONS

Repair of such injuries is technically demanding. A hybrid approach may reduce the risk of complications and offer excellent long-term outcomes.

CLINICAL IMPACT

The hybrid approach to the treatment of traumatic popliteal pseudoaneurysms combines the advantages of both open and endovascular approaches. It may be possible to make an acute operation just as safe as an elective operation by implementing the proposed strategy. The procedure can be performed by surgeons of all levels, and patients may benefit from a safer surgical dissection with fewer complications and blood loss. This smart combination of standard techniques may prove invaluable in a hostile surgical environment where limb loss is likely.

Case Report: A left ventricular pseudoaneurysm detected by cardiac magnetic resonance more than 1 year after a percutaneous transluminal coronary intervention

Pseudoaneurysm is a rare but lethal complication of acute myocardial infarction. In this study, we present a unique case of a patient with left ventricular free wall rupture detected by cardiac magnetic resonance more than 1 year after a percutaneous transluminal coronary intervention.

The CT-guided percutaneous drainage of pancreatic pseudocyst accompanied by pseudoaneurysm: A case report

RATIONALE

This case report discusses the CT-guided percutaneous drainage of a pancreatic pseudocyst accompanied by a pseudoaneurysm. Pancreatic pseudocysts can erode the peripancreatic artery and produce pseudoaneurysms. This is rare, but it can be life-threatening.

PATIENT CONCERNS

The case presented involves a 58-year-old female who was diagnosed with pancreatic cancer and underwent surgical treatment. She presented with hematochezia, dizziness, and hypodynamic findings with no obvious cause. Imaging revealed a pancreatic pseudocyst and small arterial aneurysms. To reduce the risk of aneurysm rupture, the patient underwent transcatheter arterial coil embolization. Three days later, CT-guided catheter drainage was performed to reduce the erosion of the arterial wall caused by pancreatic fluid.

DIAGNOSES

The contrast-enhanced-CT imaging showed a round, slightly high-density lesion in the cyst, suggesting the presence of a pseudoaneurysm.

INTERVENTIONS

The patient was sent for another transcatheter arterial embolization with coils and n-butyl-2-cyanoacrylate.

OUTCOMES

After receiving the transcatheter arterial embolization, the patient had no serious bleeding or other complications.

LESSONS

Early detection and accurate assessment of pseudoaneurysms are essential for appropriate management. This case shows that contrast-enhanced CT is necessary before CT-guided percutaneous drainage of pancreatic pseudocysts. It also shows that, due to the many complications that pancreatic pseudocysts may cause, appropriate treatment of pseudocysts complicated with pseudoaneurysm has important clinical significance.

Delayed Presentation of a Post-traumatic Suprascapular Artery Pseudoaneurysm

Thyrocervical trunk pseudoaneurysms are a rare entity among pseudoaneurysms, mostly caused by trauma. We present the case of a 74-year-old male who suffered a traumatic pseudoaneurysm of the supra-scapular artery after a rib and scapular fracture. The patient was treated with various interventions along the treatment algorithm, including ultrasound-guided thrombin injection, coil embolization, and surgical excision. In our patient, the pseudoaneurysm was successfully treated with coil embolization, but a persistent thrombosed pseudoaneurysm caused the patient discomfort, prompting the eventual surgical removal. This case is unique as it enlightens the step-wise approach to managing thyrocervical trunk pseudoaneurysm.

Repeat imaging increases detection of delayed pseudoaneurysms in patients with high-grade solid organ injury following abdominal trauma

BACKGROUND

Nonoperative management of abdominal trauma can be complicated by the development of delayed pseudoaneurysms. Early intervention reduces the risk of rupture and decreases mortality. The objective of this study is to determine the utility of repeat computed tomography (CT) imaging in detecting delayed pseudoaneurysms in patients with abdominal solid organ injury.

METHODS

A retrospective cohort study reviewing Montreal General Hospital registry between 2013 and 2019. Patients with The American Association for the Surgery of Trauma (AAST) grade 3 or higher solid organ injury following abdominal trauma were identified. A chart review was completed, and demographics, mechanism of injury, Injury Severity Score (ISS) score, AAST injury grade, CT imaging reports, and interventions were collected. Descriptive analysis and logistic regression model were completed.

RESULTS

We identified 195 patients with 214 solid organ injuries. The average age was 38.6 years; 28.2% were female, 90.3% had blunt trauma, and 9.7% had penetrating trauma. The average ISS score was 25.4 (SD 12.8) in patients without pseudoaneurysms and 19.5 (SD 8.6) in those who subsequently developed pseudoaneurysms. The initial management was nonoperative in 57.0% of the patients; 30.4% had initial angioembolization, and 12.6% went to the operating room. Of the cohort, 11.7% had pseudoaneurysms detected on repeat CT imaging within 72 h. Grade 3 represents the majority of the injuries at 68.0%. The majority of these patients underwent angioembolization.

CONCLUSIONS

In patients with high-grade solid organ injury following abdominal trauma, repeat CT imaging within 72 h enabled the detection of delayed development of pseudoaneurysms in 11.7% of injuries. The majority of the patients were asymptomatic.

Multiple Aneurysms or Pseudoaneurysms of the Gastroepiploic Artery: An Anecdotal Cause of Hemoperitoneum

Gastroepiploic artery aneurysms and pseudoaneurysms pose diagnostic challenges due to their rarity and overlapping radiological features. This case report presents an 82-year-old woman with sudden-onset severe abdominal pain with computed tomography revealing hemoperitoneum and saccular dilations adjacent to the stomach's greater curvature, suggestive of vascular pathology. Selective abdominal arteriography confirmed three saccular dilatations in the gastroepiploic artery, which were managed successfully with coil embolization. The discussion emphasizes the importance of accurate diagnosis, distinguishing between aneurysms and pseudoaneurysms, and prompt intervention to mitigate the risk of hemorrhagic complications of either of them. The case underscores the significance of endovascular management in such rare and critical scenarios.

Pseudoaneurysm of cystic artery stump after laparoscopic cholecystectomy managed successfully with branch hepatic artery embolization using jail technique

An unusual manifestation caused by cholecystitis, infection, or iatrogenic damage after cholecystectomy is a pseudoaneurysm of the cystic artery. We report this rare illness in a 64-year-old man who visited the emergency room with hematemesis and anemia. The patient initially experienced acute cholecystitis and then underwent a laparoscopic cholecystectomy following which he developed a cystic artery pseudoaneurysm, secondary to infected fluid collection. Based on the patient's history and contrast-enhanced computer tomography abdomen, a diagnosis of pseudoaneurysm of the cystic artery was made. Angioembolization of the hepatic artery branch was performed to occlude the pseudoaneurysm.

Incidence, risk factors, and management following cardiac catheterization via carotid and axillary artery approaches: A single-center experience on pseudoaneurysms in young infants

BACKGROUND

Use of alternate access for complex neonatal interventions has gained acceptance with carotid and axillary artery access being used for ductal and aortic interventions.

METHODS

This study was a retrospective, single-center study at Cincinnati Children's Hospital Medical Center. The study included infants, aged ≤90 days, who underwent cardiac catheterization with either carotid or axillary artery access between 2013 and 2022. Data encompassing demographics, clinical information, catheterization data, and the incidence of pseudoaneurysm as a procedural complication were collected.

RESULTS

Among 29 young infants (20 males, 69%), 4 out of 15 patients (27%) who underwent the carotid approach developed pseudoaneurysms, while 1 out of 14 patients (7.1%) who underwent the axillary approach developed one. Two patients required transcatheter intervention due to enlargement of pseudoaneurysms, involving the placement of transarterial flow-diverting stent and occlusion of left common carotid artery. Longer sheath in-to-out time (135 vs. 77 min, p = 0.001), and higher closing activated clotting times (ACT) (268 vs. 197 s, p = 0.021) were observed among patients with pseudoaneurysms compared to those without.

CONCLUSIONS

Young infants with alternative access via the carotid and axillary arteries may be at risk of pseudoaneurysm formation during longer procedures and with higher ACTs for closure. Ultrasound-guided compression can be employed to prevent the progression and in resolution of these lesions.

Anesthetic Challenges in a Patient With an Expanding Recurrent Mycotic Pseudoaneurysm of the Right Brachiocephalic Artery: A Case Report and Literature Review

Airway obstruction requires urgent intervention. When dealing with the right brachiocephalic artery mycotic pseudoaneurysms, the risk of rupture and massive hemorrhage adds greater urgency to the management. Furthermore, tracheal compression presents difficulties during airway management. This report highlights the airway and anesthetic challenges encountered during the procedure and emphasizes the importance of tailored intervention for optimal patient care. We describe the clinical case of a 38-year-old male patient who presented with a large recurrent right brachiocephalic artery pseudoaneurysm associated with tracheal compression. The patient required urgent surgical intervention due to the pseudoaneurysm's enlargement and progressive respiratory distress. Awake fiber-optic intubation was not feasible. A cardiopulmonary bypass was kept on standby in the event of failed intubation and ventilation, or circulatory collapse. Endotracheal intubation was performed successfully using a video-laryngoscopy. After successful surgical repair of the pseudoaneurysm, the patient was transferred to ICU where he was extubated 48 hours post-surgery, following treatment with methylprednisolone for edematous aryepiglottic folds identified during video-laryngoscopy. Overall, this case emphasizes the importance of early diagnosis, prompt surgical intervention, and effective teamwork in managing rare and potentially life-threatening conditions like mycotic pseudoaneurysms. It also highlights the critical role of anesthesiologists in providing optimal perioperative care, ensuring hemodynamic stability, managing airway challenges, and facilitating successful surgical outcomes. In our work, we also provide a summary of the reported similar cases.

Spontaneous bilateral superficial femoral artery pseudoaneurysms and a unilateral posterior tibial artery aneurysm in an immunocompromised patient

Key Clinical Message

The presence of multiple pseudoaneurysms in a patient should prompt investigations for the underlying etiologies including autoimmune and immunosuppressive disease processes. Treatment options include open repair and endovascular stenting.

Abstract

Pseudoaneurysms (also known as false aneurysms) are atypical dilatations or outpouchings from a vessel which are not always contained by the three layers of a normal vessel wall, namely the intima, media, and adventitia. These are distinct from a true aneurysm which has a wall comprising all three layers. The underlying etiology for both true aneurysms and pseudoaneurysm can vary. We present the rare case of bilateral superficial femoral artery pseudoaneurysms, of unknown etiology and a concurrent posterior tibial artery saccular aneurysm in a patient with Human Immunodeficiency Virus (HIV) infection and multiple comorbidities. This was managed using a combination of endovascular covered stent grafts and open surgical repair technique. The patient is doing well on follow-up a year later with no post-operative infections. A literature review of the existing reports of superficial femoral artery pseudoaneurysms and posterior tibial artery aneurysms and their management is also reported.

Pseudoaneurysm after arterial reconstruction in kidney transplant nephrectomy: A case report and literature review

Background

Pseudoaneurysm formation sometimes complicates transplant nephrectomy. We report a case of bleeding from a pseudoaneurysm after transplantation nephrectomy that resulted in shock and emergency endovascular treatment.

Case presentation

A 56-year-old man underwent transplant nephrectomy 3 years and 9 months following transplantation for pyelonephritis-related infection control. On postoperative day 7, he developed sudden pain in the lower abdomen and subsequently went into shock. A pseudoaneurysm at the anastomosis was detected, and urgent endovascular treatment was performed to stem the bleeding.

Conclusion

Vascular complications, including pseudoaneurysms, following transplant nephrectomy can be life-threatening, and comprehensive awareness is needed in careful postoperative management.

A guidewire-free approach for percutaneous closure of left ventricular pseudoaneurysm

A 78-year-old male patient with a history of coronary artery disease (he had undergone coronary artery bypass surgery 4 years ago), heart failure with mildly reduced ejection fraction, diabetes mellitus, and transient ischemic attack presented to the emergency department with complaints of dyspnea (New York Heart Association Class 4) despite the optimal medical therapy.

Incidence and management of traumatic vertebral artery injuries: wartime experience in Ukraine

OBJECTIVE

Modern combat-related vertebral artery (VA) injuries are increasingly being diagnosed, but the management of such injuries remains controversial. The authors report the frequency and characteristics of combat-related penetrating VA injuries and the indications for endovascular treatment, as well as analyze their treatment outcomes.

METHODS

A 1-year prospective study was completed at a civilian medical center in Dnipro, Ukraine, in all patients with VA injuries sustained during the Russian invasion in the 1st year of war. The authors evaluated the location, type, and severity of the VA injuries and concomitant injuries, as well as the type of intervention and outcomes at 1 month.

RESULTS

In total, 279 wounded patients underwent cerebral angiography and 30 (10.8%) patients had VA injuries. All patients were male. There were 28 soldiers and 2 civilians with a mean age of 37.5 years. Four (13.3%) patients had Bissl grade I injuries, 4 (13.3%) had grade II injuries, 4 (13.3%) had grade III injuries (pseudoaneurysm), and 18 (60.0%) had grade IV injuries (occlusion). Four (13.3%) patients underwent emergency open surgical intervention. Fourteen (46.7%) patients underwent endovascular intervention. There was a significant relationship between the anatomical level of the VA injury and surgical intervention (p < 0.05). Endovascular intervention was correlated with the severity of vascular injury to the VA, with 12.5% of the patients receiving intervention for grade I and II lesions and 59.1% receiving intervention for grade III and IV lesions (p < 0.05). The overall mortality in the study group was 6.7% (n = 2), and both died of ischemic complications.

CONCLUSIONS

In modern armed conflicts, VA injuries are much more common than reported for previous wars. With the available modern endovascular technology, cerebral angiography is warranted for suspected VA injury and allows for both the diagnosis and treatment of these injuries. Whether endovascular intervention is performed depends on the level and severity of VA injury, severity of concomitant injuries, and presence of collateral circulation.

Characteristics of Vascular Access Cannulation Complications in End Stage Kidney Disease Patients in West Java from 2018 to 2022: A Retrospective Observational Study

Background

End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications.

Materials and Methods

This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record.

Results

Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010).

Conclusion

Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma.

Thrombin injection under B-flow and ultrasound guidance: A safe and effective treatment of pseudoaneurysms

PURPOSE

To evaluate the method of thrombin injection under B-flow and ultrasound guidance (BUGTI) for the treatment of pseudoaneurysms.

MATERIALS AND METHODS

Twenty-one patients suffering from pseudoaneurysm (PSA) were retrospectively reviewed at the First Affiliated Hospital of Nanjing Medical University in Nanjing, China, from January 2018 to August 2019. The patients were treated using an ultrasound-guided injection of thrombin (500 IU/mL) combined with B-mode blood flow imaging (B-flow). The information on the PSA, including the size of the arterial rupture and sac, flow rate, thrombin dose, and treatment outcome, was recorded during the procedure. Follow-up evaluation was performed at 1, 3, and 6 months after the treatment. Pearson's correlation analysis was performed among the characteristics of PSA and the dose of thrombin.

RESULT

The age of patients ranged from 34 to 80 years and averaged 62.8 years. The maximum cross-sectional area of PSA ranged from 208 to 1148 mm2. All patients were treated with thrombin injections. The dose of thrombin ranged from 300 to 1667 IU. No reperfusions were detected at follow-up 6 months, and the BUGTI treatment was successful in all 21 cases. Pearson's correlation analysis demonstrated that the dose of thrombin was positively correlated with the width (r = 0.449, p < .05) and maximum cross-sectional area (r = 0.504, p < .05) of PSA.

CONCLUSION

Thrombin injection under B-flow and ultrasound guidance is a rapid and effective treatment for PSA. Additionally, the sac size could be used to estimate the dose of thrombin.

The Role of Anticoagulants and Platelet Aggregation Inhibitors in the Treatment of Pseudoaneurysms and Risk of Venous Thrombosis

Pseudoaneurysms (PSA) are one of the most common complications after arterial punctures. This retrospective study examined whether platelet aggregation inhibitors (APT) or anticoagulants (AC) lower the success rates of PSA treatment. A total of 468 patients with PSA were retrospectively analyzed between 2010 and 2018, and 238 were included in the study. Despite co-medication with APT or AC, thrombin injection (TI) was superior to compression bandage (CB) therapy in treating PSA (TIwAC 79 vs CBwAC 51%; P = .004 and TIwAPT 93 vs CBwAPT 54%; P = .001). There was no decrease in PSA-associated thrombosis in patients requiring anticoagulation after TI. The success rates of the TI and CB groups were compared in patients with and without AC therapy, and the latter was significantly lower. A reduced success rate was not observed in CB therapy patients requiring APT. In contrast, better results were seen in the TI group. Regarding PSA treatment, TI therapy is significantly superior to CB, including in patients requiring concomitant AC or APT therapy. PSA-associated thrombosis also occurs in patients requiring anticoagulation, and sonography should be performed. Concomitant medication use with APT does not significantly influence PSA therapy success or prevention of PSA-associated thrombosis.

Surgical Treatment of a Giant Proximal Ulnar Artery Aneurysm Potentially Associated With Subacute Endocarditis

Ulnar artery aneurysms (UAAs), although infrequent, pose limited challenges in terms of timely diagnosis and surgical intervention. Their intricacy lies in discerning and addressing the underlying pathology, often necessitating prolonged hospitalization. Herein, we present a case detailing a giant aneurysm located in the proximal ulnar artery, measuring 5.2 cm in diameter. The patient exhibited negative microbial cultures and non-pathological transthoracic echocardiography (TTE). Successful treatment involved aneurysmal exclusion and saphenous vein graft interposition. While the initial microbiological cultures and TTE yielded negative results, the diagnosis of endocarditis was ultimately confirmed through a subsequent transesophageal echocardiography (TEE) examination. This case report underscores the imperative for heightened clinical suspicion when confronted with upper-limb aneurysms. The diagnostic process necessitates sustained diligence for identifying the underlying pathology, a task that, in certain instances, requires prolonged hospitalization. Both microbiological cultures and TTE have exhibited diminished sensitivity in the diagnosis of infective endocarditis and should consistently be complemented by TEE.

Endoscopic Ultrasound-Guided Glue Embolization for Left Gastric Artery Pseudoaneurysm Presenting as Hemosuccus Pancreaticus After Failed Radiological Intervention

Hemosuccus pancreaticus is characterized by intermittent bleeding from the ampulla of Vater due to the rupture of a pseudoaneurysm. There are significant diagnostic and therapeutic challenges associated with this rare and potentially life-threatening condition. We present a rare case in an 18-year-old man who presented with recurrent episodes of hematemesis and melena due to hemosuccus pancreaticus as a result of a left gastric artery pseudoaneurysm. Initial radiological angioembolization failed because of median arcuate ligament syndrome, and endoscopic ultrasound-guided glue embolization was successfully performed. This case further reinforces the importance of endoscopic ultrasound-guided therapy in the management of pseudoaneurysm after failed radiological treatment.

Axillary artery pseudoaneurysm with concurrent distal thrombosis: a case report

This report details a case of axillary artery pseudoaneurysm with concurrent distal thrombosis, manifesting as acute upper extremity ischemia. The condition was successfully treated with a hybrid surgical approach, employing a covered stent graft and Fogarty balloon thrombectomy. We review the relevant literature on the management of this rare but critical vascular condition.

Anastomotic Pseudoaneurysm in Kidney Transplant: A Challenging Management for a Rare Entity

PURPOSE

Anastomotic pseudoaneurysms of transplanted kidneys are a very rare complication encountered in less than 1% of cases. They may be devastating, leading to functional impairment, kidney transplantectomy, or death. Treatment has not been standardized, with open surgical repair considered the safest procedure even if it is often complicated by bleeding and graft loss. The purpose of this case report is to describe an endovascular treatment of this condition, consisting of the combination of coil embolization and arterial stenting.

CASE REPORT

A 61-year-old woman developed an anastomotic pseudoaneurysm 2 months after kidney transplantation, causing acute kidney injury related to ab-extrinsic stenosis of the transplant renal artery (TRA) and external iliac artery. The pseudoaneurysm was successfully treated by coil embolization, and the arterial patency was restored by the stenting of TRA and external iliac artery. The patient completely recovered kidney function, and after a 6-month-follow-up, creatinine values were stable with normal renal perfusion.

CONCLUSION

Endovascular repair through coil embolization and TRA stenting can be a safe and effective option to treat anastomotic pseudoaneurysm in kidney transplant.

Occurrence of pseudoaneurysm of the coronary button due to aortic remodeling after Bentall operation

Here, we present a case report detailing a pseudoaneurysm of the coronary button due to aortic remodeling that occurred 2 years after aortic root replacement. The patient was referred to our hospital with a diagnosis of left coronary artery pseudoaneurysm. Intraoperative findings revealed substantially loosened sutures in both the left and right coronary arteries with bleeding. Specifically, the left coronary artery was detached at the 6-9 o'clock positions. The operation was concluded with ligation of the loose suture and addition of a new suture. Chronic dissection thickened the aortic wall of the coronary artery ostium in the initial Bentall operation, whereas the sutured coronary button in this operation exhibited a normal arterial wall without a thickened dissected intima. This suggests that aortic wall remodelling of the coronary ostium leads to suture loosening and subsequent haemorrhage. Aortic wall remodeling may lead to bleeding or pseudoaneurysms during the remote period.

Balloon-Assisted Thrombin Injection of a Profunda Femoral Pseudoaneurysm Using Radial Access

The profunda femoral artery is an uncommon location for a pseudoaneurysm and is technically challenging to resolve with traditional techniques, such as ultrasound-guided compression or thrombin injection, owing to its deep anatomical location. Balloon-assisted thrombin injection (BATI) is a technique that has been shown to be effective using contralateral access for technically difficult pseudoaneurysms in high-risk surgical patients. We report a case of BATI using radial access in a patient with a profunda femoral artery pseudoaneurysm.

Spontaneous development and involution of a de novo pseudoaneurysm at the superficial temporal artery-middle cerebral artery bypass anastomotic site in a patient with moyamoya disease: illustrative case

BACKGROUND

De novo pseudoaneurysm formation is a rare complication of extracranial-intracranial bypass surgery.

OBSERVATIONS

The authors report the case of a 28-year-old male who presented with new-onset right temporal and occipital ischemia who was found to have bilateral proximal internal carotid artery occlusion with collateral vasculature formation consistent with moyamoya disease. The patient underwent bilateral superficial temporal artery-middle cerebral artery bypasses. A de novo pseudoaneurysm was found at the left-sided bypass distal anastomotic site recipient vessel 1 month after the surgery. The pseudoaneurysm demonstrated a progressive reduction in size and eventual complete involution at 6 months after surgery.

LESSONS

Limited literature reports extracranial-intracranial bypass-associated aneurysms treated primarily with either clipping or resection and reanastomosis. The authors demonstrate, for the first time, a progressively benign natural history course of an extracranial-intracranial bypass distal anastomotic site pseudoaneurysm.

Conservative Management of LVAD-Associated Ventricular Pseudoaneurysm

Left ventricular assist devices (LVAD) are surgically implanted mechanical support devices utilized with increasing frequency as a bridge to myocardial recovery, destination therapy, and heart transplantation. While the use of such devices in patients with advanced heart failure has shown significant survival benefits and improved quality of life, they bear their own risks and complications.1 Bleeding, infection, pump thrombosis, and stroke are just some of the serious complications associated with LVADs.2 LVAD-associated pseudoaneurysms are rare, with prior reports of occurrence at the left ventricular apex and at the anastomosis site of the outflow graft to the ascending aorta.3,4 Typically, this device-related complication requires surgical repair and, if at all feasible, heart transplantation. However, in cases of difficult anatomy, unfavorable position, and significant comorbidities, surgery may be contraindicated due to high surgical risk. This case portrays a patient suffering from a left ventricular pseudoaneurysm after HeartMate-III implantation that was not amenable to surgical repair due to heightened surgical risk. We document the first pseudoaneurysm associated with the HeartMate-III in available literature and describe a novel management strategy of documented nonoperative course of LVAD-associated pseudoaneurysm, with the patient surviving 56+ months with medical optimization and management.

Nonoperative Management of Iatrogenic Right Atrial Appendage Pseudoaneurysm During Catheter Ablation

Atrial pseudoaneurysms are exceedingly rare. Cardiac pseudoaneurysms are at risk for rupture, which may be catastrophic and require emergent thoracotomy for definitive treatment. We report a case of right atrial appendage perforation during catheter ablation leading to tamponade and right atrium pseudoaneurysm.

Azygos Vein Pseudoaneurysm After Trauma: A Case Report

High-speed motor vehicle collisions (MVCs) often result in severe musculoskeletal, neurological, and vascular injuries. Among these, azygos vein pseudoaneurysms (AVPs) are a rare and potentially life-threatening vascular complication. Our case study highlights an instance of an AVP arising from a high-velocity MVC, underscoring their critical significance in trauma scenarios. Additionally, this report delves into the complexities of managing AVPs, both traumatic and idiopathic, emphasizing the urgent need for intervention and the intricacies of their treatment.

Pseudoaneurysm of the superficial temporal artery after sagittal split ramus osteotomy: A case report

Sagittal split ramus osteotomy (SSRO) is a widely performed orthognathic surgery; however, among the various reported complications of SSRO, pseudoaneurysms are rarely reported. Pseudoaneurysms are rare vascular lesions formed by damage to the arterial wall that can occur after trauma or postoperatively, causing uncontrolled bleeding. The present report describes a case of a pseudoaneurysm that occurred after SSRO in a 22-year-old female patient. Le Fort I osteotomy and bilateral SSRO were performed under general anesthesia to improve the gummy smile and mandibular asymmetry of the patient. While osteotomizing the medial side of the left SSRO, major bleeding occurred from the soft tissue of the posterior margin of the mandibular branch. Direct compression with gauze and a local hemostatic agent stopped the bleeding. Immediately after returning to the ward, bleeding was observed from the left wound site and marked swelling of the left buccal area occurred. Contrast-enhanced computed tomography revealed a pseudoaneurysm of the left superficial temporal artery (STA). Subsequently, arterial embolization for the pseudoaneurysm was performed. Overall, the present report describes a rare case of pseudoaneurysm of the STA as a postoperative complication of SSRO.

Spectrum of Multidetector Computed Tomography Imaging Findings in Iatrogenic Abdominopelvic Injuries: A Comprehensive Pictorial Review

Iatrogenic injuries are unavoidable complications of surgeries and minimally invasive procedures. They are generally classified into vascular and nonvascular injuries and based on the time of injury into early and late injuries. Iatrogenic injuries, particularly vascular injuries, increase the mortality and morbidity, with prolongation of hospital-stay. Multidetector computed tomography (MDCT) is a highly sensitive, and often the first imaging modality in suspected iatrogenic injuries. This pictorial review elucidates the imaging considerations and appearances of iatrogenic injuries of the abdominopelvic organs on MDCT.

Recurrent Postpartum Hemorrhage: A Case of Uterine Artery Pseudoaneurysm Probably Induced by Anticoagulants

Pseudoaneurysm formation often occurs when there is inadequate sealing at an arterial puncture site. We present the case of a 27-year-old primigravida with rheumatic heart disease and a history of mitral valve replacement on anticoagulants who experienced recurrent episodes of postpartum hemorrhage (PPH). Despite conservative management and adjustments to anticoagulant therapy, the bleeding persisted. Further investigations revealed a small pseudoaneurysm originating from the left uterine artery. Bilateral uterine artery embolization (UAE) using polyvinyl alcohol particles was successfully performed. The patient's condition improved, and she was discharged on a carefully regulated medication regimen. This case highlights the importance of considering rare causes of PPH in high-risk patients, such as uterine artery pseudoaneurysm. Anticoagulants could be a potential contributor of its spontaneous rupture. Prompt diagnosis and appropriate intervention, such as UAE, can effectively manage PPH and prevent adverse outcomes.

Post-Traumatic Radial Artery Pseudoaneurysm at the Wrist Level: A Case Report

A pseudoaneurysm is a collection of blood outside the arterial lumen but remains in continuity with the lumen and lined by fibrous tissue. Radial artery pseudoaneurysm is a rare entity mostly occurring due to iatrogenic reasons. Traumatic causes are rare. In this case report, we report a post-traumatic left radial artery pseudoaneurysm at the wrist level in a 20-year-old male patient. The patient was treated with end-to-end repair of excised pseudoaneurysm with a vein graft taken from the radial artery vena comitantes through the same incision.

Predictive factors of delayed bleeding after percutaneous nephrolithotomy requiring angioembolization

Objectives

To investigate the predictive factors of delayed post-percutaneous nephrolithotomy (PCNL) haemorrhage because of arteriovenous fistula (AVF) or pseudoaneurysm (PA) and compare the factors between AVF and PA.

Patients and methods

This is a case-control study with a case-to-control ratio of 1:3. Out of 5077 patients who underwent PCNL from April 2015 to April 2018 in three different teaching hospitals, 113 had post-PCNL haemorrhages because of AVF and/or PA. Seventy-two patients met the inclusion criteria and entered the study as cases, while 216 patients without any postoperative complications were selected as controls.

Results

Of all 72 studied patients with complications after PCNL, 35 (48.6%) had AVF, and the rest had PA. The regression model revealed that a history of diabetes (odds ratio [OR]: 2.799, 95% confidence interval [CI]: 1.392-5.630, p-value = 0.004) and renal anomalies (OR: 2.929, 95% CI: 1.108-7.744, p-value = 0.03) were associated with developing delayed post-PCNL haemorrhage. However, no differences were seen between AVF and PA regarding selected variables (p-value > 0.05).

Conclusion

History of diabetes and renal anomalies were predictive factors for delayed post-PCNL haemorrhage, but no predictive factors were found to differentiate PA and AVF from one another.

Radiological findings and endovascular management of internal carotid artery pseudoaneurysm in the setting of mucormycosis and COVID-19

The coronavirus pandemic is now a public health emergency and has spread to nearly 206 countries across the globe. This novel disease has shaken the psycho-social, economic, and medical infrastructure of India. This has become even more challenging, considering the country's huge population. With the increase in the number of coronavirus disease (COVID) cases, our country has seen an unforeseen, unprecedented rise in a potential life and organ-threatening disease-mucormycosis. Mucormycosis is a deadly, extremely morbid, possibly life-threatening, and most feared complication of the coronavirus, caused by environmental molds belonging to the order Mucorales. Here, we report 2 cases of massive epistaxis due to internal carotid artery (ICA) pseudoaneurysm secondary to mucormycosis, post-COVID-19 pneumonia, which was managed by the endovascular route. To the best of our knowledge, there is very sparse literature available describing endovascular treatment of intracranial ICA pseudoaneurysm in a patient with COVID-induced mucormycosis.

Iatrogenic Carotid Artery Pseudoaneurym: Successful Treatment With Percutaneous Thrombin Injection

This report demonstrates the successful treatment of a carotid artery pseudoaneurysm using percutaneous thrombin injection. The patient, a 62-year-old woman with multiple comorbidities, experienced a pseudoaneurysm following an unintentional carotid artery puncture during a failed attempt to place a triple lumen catheter in the right jugular vein. Percutaneous thrombin injection was chosen as the treatment method, with Doppler ultrasound monitoring. Follow-up examinations showed no signs of recurrence, and the patient was discharged after nine days without complications.

Traumatic Pseudoaneurysms of the Internal Mammary Artery: Two Cases and Percutaneous Intervention

Pseudoaneurysms involving the internal mammary artery/internal thoracic artery (IMA/ITA) are rare occurrences, and the presentation and treatment approaches for such cases can be variable. Due to the potentially life-threatening risk of rupture, leading to conditions like hemothorax, it is important to have a comprehensive understanding of safe and effective diagnostic and therapeutic techniques. We present two cases of IMA/ITA artery pseudoaneurysms. A 91-year-old male presented to the emergency department following a motor vehicle accident. A CT scan of the chest revealed an anterior mediastinal hemorrhage with active extravasation. Percutaneous intervention revealed a pseudoaneurysm arising from a left IMA/ITA side branch. Coil embolization effectively treated the pseudoaneurysm. In the second case, a 79-year-old male presented with a sternal fracture after a ground-level fall, with parasternal hematoma and active bleeding (pseudoaneurysm) on Trauma Computerized Tomography of the chest with contrast. He underwent coil embolization, and subsequent post-procedure angiograms confirmed the effective occlusion of the left IMA/ITA, with no further visualization of the pseudoaneurysm. These two cases underscore the importance of tailored approaches in treating internal mammary artery pseudoaneurysms.

Balloon-mounted covered stent as endovascular management of a traumatic cervical internal carotid artery pseudoaneurysm in a 23-year-old: a case report

Background

Distal cervical internal carotid artery (cICA) pseudoaneurysms are uncommon. They may lead to thromboembolic or hemorrhagic complications, especially in young adults. We report one of the first cases in the literature regarding the management via PK Papyrus (Biotronik, Lake Oswego, Oregon, USA) balloon-mounted covered stent of a 23-year-old male with an enlarging cervical carotid artery pseudoaneurysm and progressive internal carotid artery stenosis.

Case Description

We report the management of a 23-year-old male with an enlarging cervical carotid artery pseudoaneurysm and progressive internal carotid artery stenosis. Based on clinical judgment and imaging analysis, the best option to seal the aneurysm was a PK Papyrus 5×26 balloon-mounted covered stent. A follow-up angiogram showed no residual filling of the pseudoaneurysm, but there was some contrast stagnation just proximal to the stent, which is consistent with a residual dissection flap. We then deployed another PK Papyrus 5×26 balloon-mounted covered stent, providing some overlap at the proximal end of the stent. An angiogram following this subsequent deployment demonstrated complete reconstruction of the cICA with no residual evidence of pseudoaneurysm or dissection flap. There were no residual in-stent stenosis or vessel stenosis. The patient was discharged the day after the procedure with no complications.

Conclusions

These positive outcomes support the use of a balloon-mounted covered stent as a safe and feasible modality with high technical success for endovascular management of pseudoaneurysm.

Endovascular treatment of a ruptured aortic pseudoaneurysm and its complications in an 8-year-old child with Ehlers-Danlos syndrome type VI

The procollagen-lysine, 2-oxoglutarate 5-dioxygenase 1 (PLOD1) gene may affect arterial integrity through enzymatic roles and the modulation of vascular smooth muscle cells. We present a complicated vascular case of an 8-year-old male child with Ehlers-Danlos syndrome type VI. The patient was diagnosed with a ruptured pseudoaneurysm of the infrarenal abdominal aorta. Endovascular treatment was performed using a covered self-expandable endograft. However, complications arose at the vascular access sites during the procedure, highlighting arterial fragility. PLOD1 mutations can be associated with false abdominal aortic aneurysms or arterial fragility. Open repair poses a high risk for patients with Ehlers-Danlos syndrome. Although the long-term results are unknown, endovascular stent grafts may be a suitable option for emergency clinical scenarios such as ruptured abdominal aortic pseudoaneurysms.