The changing epidemiology of pseudoaneurysm. Therapeutic implications

To elucidate newly emerging trends in pseudoaneurysm causation, 57 patients with 81 pseudoaneurysms were reviewed. Only two (8%) of 24 pseudoaneurysms treated surgically before 1977 were infected, whereas 17 (30%) of 57 treated during the past decade were infected. There were four deaths among 12 patients (33%) with infected pseudoaneurysms compared with only one death among 45 patients (2%) with noninfected pseudoaneurysms. All five amputations were consequences of infected pseudoaneurysms. We conclude that (1) infection as a cause of pseudoaneurysm is increasing, (2) mortality and limb loss are now confined almost exclusively to cases involving infection, and (3) the current approach to pseudoaneurysm should include a high index of suspicion in patients at risk for infection, increased use of newer diagnostic scans, and an aggressive surgical attack on infected pseudoaneurysms that may require complete graft excision and extra-anatomic bypass.