Postoperative pancreatic fistula, a significant complication following pancreaticoduodenectomy, can lead to the development of pseudoaneurysms, which in turn can result in hemorrhagic and septic complications. Here, we present the case of a 67-year-old male patient diagnosed with pancreatic head carcinoma who underwent partial pancreatectomy. Ten days postsurgery, the patient experienced hemorrhagic shock due to intraperitoneal bleeding. Emergency exploratory laparotomy and implantation of a stent in the common hepatic artery successfully stopped the bleeding. However, the patient later developed gastrointestinal bleeding, and no apparent source was detected during endoscopic examination. Two complex transcatheter arterial embolization procedures were performed, successfully stopping the bleeding. It is crucial to consider pseudoaneurysm in cases of suspected biliary and pancreatic leakage. This case also underscores the importance of a thorough vascular assessment prior to placing a coated stent, to prevent postoperative obstruction of catheter access to the responsible vessel. Additionally, embolization via the external path of the stent proved feasible.

UNASSIGNED: Pseudoaneurysm of the ulnar artery (PUA) can arise secondary to several inciting etiologies and may lead to pain, arterial insufficiency, and ulnar nerve palsy. Given the relative infrequency of PUA diagnosis, there is no consensus regarding its proper diagnosis and management strategies. The purpose of this review is to summarize the existing data regarding PUA and develop an algorithm for management.
UNASSIGNED: A review was performed following PRISMA Extension for Scoping Reviews guidelines. Manuscripts were included if they 1) studied patients over the age of 18, 2) discussed specifics of the PUA and 3) detailed its management.
UNASSIGNED: Thirty-one manuscripts were included, presenting data on 32 patients with a mean ​± ​standard deviation age of 46.9 ​± ​19.6 years. Ulnar artery injury mechanism included trauma (13/32, 40.6 ​%), iatrogenic (9/32, 28.1 ​%), and inherent connective tissue disease (4/32, 12.5 ​%), among others. Ultrasonography was the most common imaging modality (14/32, 43.7 ​%), and a majority (22/32, 68.8 ​%) of patients were managed surgically, typically via pseudoaneurysm resection ​± ​venous grafting for reconstruction. Non-operative interventions included ultrasound-guided compression therapy and thrombin injection.
UNASSIGNED: While PUA are infrequently diagnosed, inciting events such as accidental or iatrogenic trauma continue to be documented, and management guidelines are lacking. Duplex ultrasonography is recommended as the first line imaging study, with subsequent Allen Test to assess for ulnar artery vs. mixed dominance for hand perfusion. A pseudoaneurysm of 3 ​cm is proposed as a general threshold for considering intervention, with caveats for smaller lesions causing pain or neurologic symptoms. This review serves as a reference for physicians who encounter PUA.

Renal transplant is the gold standard treatment for end-stage kidney disease (ESKD). Despite the evolution of renal transplant procedures, complications can still occur. Transplant renal artery pseudoaneurysm is a rare but potentially life-threatening complication, which can be asymptomatic or cause mass-effect symptoms. We report an unusual case of a pseudoaneurysm of an unfunctional renal transplant that caused a femoral nerve compression, mimicking lumbosacral radiculopathy. The case concerns a 38-year-old woman with primary focal segmental glomerulosclerosis (FSGS) that progressed to ESKD. The patient underwent a kidney transplant that failed a few years after the surgery. More than 10 years later, she presented with symptoms consistent with lumbosacral radiculopathy, which was ultimately diagnosed as femoral nerve compression caused by a transplant renal artery pseudoaneurysm. This case emphasizes that each patient\'s medical history should always be considered when assessing even common complaints because rare causes can manifest in frequent symptoms. On the other hand, this case makes us reflect on weighing up the cost/benefit of some diagnostic investigations, as it is important not only to investigate the most common causes but also to rule out, in selected patients, those that, although rare, can be life-threatening.

UNASSIGNED: This study aims to evaluate the efficacy and complications of endovascular treatment for hemorrhage caused by ruptured internal carotid artery pseudoaneurysms following radiotherapy in nasopharyngeal carcinoma (NPC) patients.
UNASSIGNED: This study retrospectively analyzed NPC patients who underwent endovascular treatment for ruptured internal carotid artery pseudoaneurysm hemorrhage after radiotherapy at Zhongshan People\'s Hospital from January 2016 to December 2022. The study aims to assess the postoperative hemostasis rate, postoperative rebleeding rate, complication rate, and 1-year postoperative survival rate.
UNASSIGNED: During the study period, 36 patients underwent endovascular treatment, of which 24 patients underwent embolization of the internal carotid artery and 12 patients underwent stenting of the internal carotid artery. The procedure success rate was 100%. The rebleeding rate at 1 year after the procedure was 5.6% (2/36, one patient with stent placement and one patient with coil embolization), and the complication rate was 11.1% (4/36, four patients with coil embolization patients). Two patients developed large-area cerebral infarction after the procedure, and two patients had different degrees of neurological impairment after the procedure. The 1-year survival rate was 91.7% (33/36).
UNASSIGNED: Ruptured internal carotid artery pseudoaneurysm hemorrhage after radiotherapy is rare but life-threatening. Endovascular treatment with coil occlusion or stenting reconstruction of the internal carotid artery provides immediate hemostasis and elimination of the pseudoaneurysm with a low rate of recurrence, which may be effective in reducing patient mortality.

A 63-year-old woman presented with a giant arteriovenous malformation (AVM) of the lower limbs associated with Parkes Weber syndrome (PWS). The AVM was supplied by 4 branches of the right profunda femoris artery and 4-stage embolization was performed. At 67 years of age, she developed a pseudoaneurysm due to the recanalization of a coiled profunda femoris artery branch arterial aneurysm. We performed re-embolization of the coiled profunda femoris artery and observed its shrinkage, but 2 months later, the pseudoaneurysm began to expand again, having a fatal course. This case indicates that battles against giant AVM-associated PWS follow a long and convoluted path. We present this case with reviewing 15 previously reported cases to improve our management of PWS.

BACKGROUND: Emergence of coronary giant pseudoaneurysm (PSA) after stent implantation is potentially catastrophic and may end up with life threatening complications if not managed promptly. There is scarcity of data in existing literature with respect to guidelines on the management of coronary PSA following stent implantation. We report the recurrence of coronary PSA following initial percutaneous management of a giant coronary PSA using multiple stent grafts.
METHODS: A 38-year-old male who underwent primary angioplasty of the right coronary artery (RCA) about a month back, presented with dull aching precordial chest pain for the last 15 days. A repeat coronary angiography revealed giant coronary PSA in proximal to mid RCA. Considering the significantly large size of the coronary PSA with symptoms of impending rupture, the giant coronary PSA was successfully excluded by implanting three sequentially coronary stent grafts. However, after one and a half months, the patient again presented with a similar kind of dull aching chest pain. We found a recurrence of coronary PSA in a segment of the coronary artery distal to the portion excluded by stent grafts. This recurrent coronary PSA was once again successfully excluded by redeploying two more stent grafts with the help of a guide extension catheter.
CONCLUSIONS: In this case, vessel wall injury as a result of aggressive post dilatation using an oversized balloon during the index procedure was the contributor to the giant coronary PSA formation. It usually appears early after the index procedure (within 4 weeks). Though the usual strategy used to exclude coronary aneurysm is by using the minimal number of stent grafts (due to the inherent increased risk of restenosis/thrombosis in stent grafts) in post angioplasty traumatic aneurysm it is prudent to exclude the entire damaged artery by placing stent grafts to prevent recurrence in segments with even minimal dilatation on initial evaluation.

We present the case of a 40-year-old female who presented with abdominal pain, hematochezia, and melena for the past week and was diagnosed with a pseudoaneurysm emanating from the mid-splenic artery. The patient was managed with endovascular cyanoacrylate glue embolization, resulting in the complete resolution of an impending catastrophic hemorrhagic shock.

Pseudoaneurysms are not uncommon in the clinic, but they have rarely been reported as a result of distal radial artery puncture. This case report is about an elderly woman who developed a pseudoaneurysm at the distal radial artery puncture site after coronary angiography via the distal radial artery. After timely treatment and long-term follow-up, the patient\'s hand wound gradually healed.

Behcet\'s disease is a multisystem inflammatory disorder, whose vascular involvement is very rare. Aneurysmal arterial involvement is the severe form of the disease, it constitutes a therapeutic challenge given its severity, and frequent secondary complications. Profunda femoral artery aneurysms (PFAAs) are extremely rare. The systematic immunosuppressive drug treatment and endovascular or surgical technique thoroughness can reduce relapse rate. We report the case of a young man in whom a false aneurysm of the profunda femoral artery revealed Behcet\'s disease. He underwent an endovascular treatment by embolization using coils; with good control after 3 months.

Total knee replacement (TKR) is a common successful surgery in terms of the outcomes. The common complications of TKR are joint infection, deep venous thrombosis (DVT), wound complication, and postoperative knee instability. Arterial complications are not common. We are presenting a 61-year-old man who underwent left TKR. Upon postoperative regular follow-up, the patient developed symptoms and clinical presentation for DVT. However, initial duplex ultrasonography was negative for DVT. Repeated duplex ultrasonography showed a pseudoaneurysm of the popliteal artery, and the diagnosis was confirmed with computed tomography (CT) angiography. Pseudoaneurysm of the popliteal artery is a rare complication following primary TKR. Our patient underwent endovascular angioplasty and stenting of the pseudoaneurysm of the left popliteal artery. The patient completed three years and six months of follow-up with an uneventful course. We selected to share our experience of this rare case because pseudoaneurysm of the popliteal artery is a rare complication after TKR, which is usually present with symptoms that can mimic DVT, such as acute lower limb swelling, calf muscle pain, and pain with passive ankle dorsiflexion. Duplex ultrasonography is the preferred first diagnostic tool, and CT angiography (CTA) is needed to confirm the diagnosis and to plan treatment. Treatment with endovascular stent proved to be safe and successful with no infection risk or need for modifying rehabilitation protocol after more than three years of follow-up.