Management of iatrogenic pseudoaneurysm - single-centre experience

<b>Introduction:</b> Iatrogenic pseudoaneurysms are uncommon but increasingly encountered complications due to the rising number of percutaneous interventions. For minor lesions, conservative treatment, such as pressure or observation, is often effective. However, its effectiveness depends on many factors, which do not always allow for avoiding surgical intervention.<b>Aim:</b> The aim of this study is to evaluate the diagnostic and therapeutic strategies for iatrogenic pseudoaneurysms based on a single-center experience, with emphasis on treatment efficacy, safety, and clinical outcomes.<b>Material and methods:</b> From 2021 to 2023, 57 patients underwent surgery for iatrogenic pseudoaneurysms at the Department of General and Vascular Surgery, Clinical Hospital in Poznan. Patients were retrospectively divided into two groups: with (n = 22) or without (n = 35) prior conservative treatment. Groups were compared regarding demographics, primary procedures, diagnostic tests performed, pseudoaneurysm features, vascular access, need for red blood cell transfusion (CRC), and outcomes.<b>Results:</b> No significant differences were found between groups in gender, BMI, smoking, prior endovascular interventions, or anticoagulant use (p > 0.05). Differences were observed in the primary procedures causing pseudoaneurysms (p < 0.05). Conservative treatment was more frequent after coronary angiography, ablation, and thrombolysis. Direct surgery without conservative attempts was associated with procedures like peripheral angioplasty, pacemaker or electrode implantation, TAVI, vascular access placement/removal, and aneurysm embolisation. In both groups, no statistically significant differences were found when comparing the type of diagnostic test performed (p>0.05). No significant differences were noted in pseudoaneurysm size, multicellularity, arteriovenous fistula presence, access type, transfusion needs, or treatment outcomes (p>0.05).<b>Conclusions:</b> Management should be individualized, considering patient history, prior interventions, pharmacotherapy, and imaging. Treatment should balance efficacy and safety, guided by clinical status.