The false aneurysm after iatrogenic arterial puncture: Incidence, risk factors, and surgical treatment

Abstract

Due to the increased number of arterial punctures performed during angiography and angioplasty, the incidence of false aneurysms after arterial puncture has increased in significance. It was reported as 0.05–2%; with careful sonographic follow-up it may be twice as high. The goal of the retrospective investigation (28 patients with false aneurysms) was to elucidate risk factors leading to failure of spontaneous closure of the arterial site, and to examine symptoms and clinical courses. False aneurysms became manifest on average 16.4 days after puncture. Highest risk was seen in obese patients (64.3%), where the number of tangential and multiple vessel punctures was also highest. Further risk factors were local sclerosis, hypertension, diabetes, poor general condition, and coagulopathies. Twelve false aneurysms (42.8%) were found incidentally; diagnosis was made in all patients sonographically. In 89.3%, primary suture or patchplasty was possible and in 10.7%, more extensive vessel replacement was necessary. Postoperative complications included local infection (7.14%), recurrent false aneurysm (3.5%), and arterial bleeding (3.5%). At an average follow-up of 4.25 years, no local occlusions nor recurrent false aneurysms were seen. Preventative measures in high-risk patients (more precise puncture, prolonged compression) could reduce the morbidity of false aneurysms after puncture. Longer follow-up period would be necessary to show up the true incidence of false aneurysms and provide information on the asymptomatic courses. Surgery must be performed by experienced vascular surgeons as only at time of operation can the full extent of the arterial lesion be identified and the necessary corrective vascular procedures be performed.