Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019.
Department of Interventional Radiology, Fortis Hospital, Shalimar Bagh, New Delhi, India.
Emerg Radiol. 2023 Aug;30(4):555-561. doi: 10.1007/s10140-023-02151-8. Epub 2023 Jun 19.
Lower extremity pseudoaneurysms (PsAs) are mostly developed after traumatic or iatrogenic injury to the arteries. Unless treated, they can be complicated by adjacent mass effects, distal embolism, secondary infection, and rupture. Imaging helps in the diagnosis and planning of therapeutic intervention. Ultrasonography (USG) is often diagnostic, while CT angiography aids in vascular mapping required for intervention. Image-guided therapy offers to manage these pseudoaneurysms in a minimally invasive approach, obviating the need for surgery. A smaller, superficial, and narrow-necked PsA can easily be managed with local USG-guided compression or thrombin injection. When the percutaneous approach is not a feasible option, PsA from expendable arteries can also be managed with coiling or glue injection. Wide-necked PsA from an unexpendable artery necessitates stent graft placement, although coiling of the neck may be a viable and cheaper alternative for a long- and narrow-necked PsA. Presently, vascular closure devices are also used to seal a small arterial rent through a direct percutaneous approach. This pictorial review entails various techniques to deal with lower extremity pseudoaneurysms. An idea about the various intervention radiological approaches will help in choosing appropriate methods to tackle lower extremity pseudoaneurysms.
下肢假性动脉瘤（PsAs）大多是在动脉受到创伤性或医源性损伤后发展而来的。如果不治疗，它们可能会出现邻近肿块效应、远端栓塞、继发感染和破裂等并发症。影像学检查有助于诊断和治疗干预计划。超声检查（USG）通常具有诊断价值，而 CT 血管造影则有助于介入所需的血管成像。影像引导下的治疗为这些假性动脉瘤提供了微创治疗方法，避免了手术的需要。较小、表浅、窄颈的 PsA 可以通过局部 USG 引导的压迫或凝血酶注射轻松治疗。当经皮途径不可行时，也可以通过线圈或胶注射来治疗可消耗动脉的 PsA。来自不可消耗动脉的宽颈 PsA 需要支架移植，但对于长而窄颈的 PsA，颈线圈可能是一种可行且更便宜的替代方法。目前，血管闭合装置也可用于通过直接经皮途径封闭小的动脉裂口。本影像学综述涉及处理下肢假性动脉瘤的各种技术。了解各种介入放射学方法有助于选择合适的方法来处理下肢假性动脉瘤。
