Erbel R, Aboyans V, Boileau C, et al; ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014 Nov 1;35(41):2873-926. doi: 10.1093/eurheartj/ehu281. Epub 2014 Aug 29. Erratum in: Eur Heart J. 2015 Nov 1;36(41):2779. PubMed PMID: 25173340.
Definition, Etiology, PathogenesisTop
Aortic pseudoaneurysm refers to disruption of all aortic wall layers that does not lead to fatal exsanguination thanks to periaortic connective tissue. It represents the result of a longer (subacute or chronic) “walled-off” process, which may originate as contained rupture of the aortic wall (see Contained Rupture of Aortic Aneurysm). Aortic pseudoaneurysms may be asymptomatic or have no acute symptoms and are often detected incidentally as a chronic condition.
1) Blunt thoracic trauma in motor vehicle accidents (impact of safety belts, motor bike crashes), falls, sports injuries.
2) Iatrogenic: Aortic surgery, percutaneous catheter-based interventions.
3) Rarely, due to aortic infection or penetrating aortic ulcer.
An increase in blood pressure may cause an aortic pseudoaneurysm to rupture and result in fatal hemorrhage. In some patients aortic pseudoaneurysms may be an incidental finding.
Most aortic pseudoaneurysms, regardless of size, are considered for endovascular or surgical repair due to a relatively high risk of further growth leading to rupture. In some cases the pseudoaneurysm is treated conservatively or observed if it is long standing or stable and/or if the patient has a significant comorbidity and the repair poses a high risk.
Pseudoaneurysm rupture; fistula to veins (most common) or in some cases to other organs including the bowel, esophagus, and lung; signs and symptoms secondary to compression of the surrounding structures.