Management of traumatic arterial pseudoaneurysms as a result of limb trauma

BackgroundTraumatic arterial pseudoaneurysms (APAs) of the limbs are rare. Most published articles on this subject are case reports in the English literature. The exact epidemiology of APAs as a result of limb trauma is not well-known, and their management is not standardized. In most cases, the description of case reports is followed by a review of the literature, but no update with robust data has been previously published.PurposeOur objective was to summarize the current knowledge on the epidemiology, and diagnostic and therapeutic features of APAs as a result of limb trauma.MethodsLiterature searches on MEDLINE and EMBASE were performed using the keywords “traumatic artery pseudoaneurysm”. The referenced articles were selectively read, and the patient demographics, clinical presentations, and diagnostic and therapeutic modalities of 148 articles were reviewed.ResultsIn total, 161 cases were analyzed. Overall, young adults represented the majority of the affected population (mean age: 38 ± 24 years old), with a male preponderance (63%). The commonest presenting symptom was painful swelling (34%). Furthermore, arteriography was the most common imaging investigation used (52%). The mechanism of injury was dominated by blunt trauma (57%), and the commonest critical artery injuries included axillary-brachial (22%) and femoropopliteal trunks (16%). Moreover, PAs arising from small arterial branches were observed in 26% of the patients. The most important treatments included surgical repair (37%), endovascular procedures (29%), and ligation of the feeding vessels (26%). Post therapeutic courses were often uneventful (93%), and the morbidity (5%) and mortality (2%) rates were low.ConclusionOver the last decade, APAs related to limb trauma have increased and are often diagnosed after painful presentation of swelling and/or pulsatile mass. Angiography is an ideal option to confirm the diagnosis. Endovascular coiling is preferred in the treatment of PAs arising from small branches artery. Open surgical repair is the standard treatment for APAs arising from critical axial vessels.