Fifty-six percent of pseudoaneurysms secondary to endovascular procedures resolved with conservative management, and the factors associated with requiring invasive treatment were sac diameter ≥3 cm and ≥30 days to request angiologic evaluation.
Key Findings
Results
The majority of pseudoaneurysms following endovascular procedures resolved without invasive intervention, but nearly half required invasive treatment.
48 patients total were evaluated at a tertiary care unit in western Mexico over January 1 to December 31, 2022.
56% (n=27) resolved with conservative management (Group 1).
44% (n=21) required invasive treatment (Group 2).
Procedures involved included cardiac catheterization, peripheral angioplasty, and transcatheter aortic valve implantation (TAVI).
Results
Sac diameter ≥3 cm was significantly associated with requiring invasive treatment for pseudoaneurysm.
81% of patients in the invasive treatment group (Group 2) had a sac size ≥3 cm, compared to 22% in the conservative treatment group (Group 1).
This difference was statistically significant (p = 0.001).
Sac diameter ≥3 cm was identified as one of the two main factors associated with need for invasive management.
Results
Delayed referral for angiologic evaluation (≥30 days) was significantly associated with requiring invasive treatment.
Mean time to referral for evaluation was 158 ± 34.4 days in the invasive treatment group (Group 2) versus 6.86 ± 1.32 days in the conservative treatment group (Group 1).
This difference was statistically significant (p = 0.032).
Time ≥30 days to request angiologic evaluation was identified as one of the two main factors associated with need for invasive management.
Results
Patients requiring invasive treatment were significantly younger than those managed conservatively.
Mean age in Group 2 (invasive) was 62.67 ± 16.93 years versus 66.48 ± 11 years in Group 1 (conservative).
This difference was statistically significant (p = 0.018).
Results
Femoral access was common in both groups but did not significantly differ between treatment groups.
Femoral access was used in 62% of Group 2 (invasive) patients versus 52% of Group 1 (conservative) patients.
This difference was not statistically significant (p = 0.125).
Background
Pseudoaneurysms have a prevalence of 0.5–2% and are associated with multiple procedural and patient-related risk factors.
Etiological factors include arterial puncture, needle and introducer size, use of ultrasound, duration or complexity of the procedure, use of anticoagulation, and closure devices.
Patient risk factors include age ≥75 years, female sex, chronic kidney disease, systemic arterial hypertension, type 2 diabetes mellitus, cardiac arrhythmia, infected tissues, and multiple puncture attempts.
Study design was an analytical cross-sectional study with a longitudinal component; a p value ≤0.05 was considered statistically significant.
What This Means
This research examined how pseudoaneurysms — a complication where blood leaks out of a blood vessel and pools in surrounding tissue after a procedure — were managed at a major hospital in western Mexico. The study looked at 48 patients who developed this complication following procedures such as heart catheterizations, peripheral artery interventions, or heart valve replacements performed through blood vessels. About 56% of patients healed with conservative (non-surgical) care, while 44% needed more invasive treatment such as additional procedures or surgery.
The study found two key factors that were linked to needing invasive treatment: having a larger pseudoaneurysm (a sac size of 3 cm or more) and waiting 30 days or longer before being referred to a vascular specialist for evaluation. Patients in the invasive treatment group waited an average of 158 days before being seen by a specialist, compared to less than 7 days for those who were successfully managed conservatively. The size of the pseudoaneurysm and how quickly the patient was evaluated appear to be critical in determining whether less aggressive treatment will work.
This research suggests that early referral to a vascular specialist after an endovascular procedure complication may improve the chances of resolving pseudoaneurysms without invasive intervention. Smaller pseudoaneurysms identified and treated early were much more likely to resolve on their own or with simple measures. These findings highlight the importance of timely diagnosis and prompt specialist consultation in managing this relatively uncommon but potentially serious complication of common heart and vascular procedures.
Páez-Sánchez M, Calderón-Llamas M, Nuño-Escobar C, Guerrero-Jauregui J, Rodríguez-Ortega H, Ramírez-Plascencia J, et al.. (2026). [Management of pseudoaneurysm associated with endovascular treatments at third level].. Revista medica del Instituto Mexicano del Seguro Social. https://doi.org/10.5281/zenodo.19099389