0:01

So let's look at this patient,

0:02

17-year-old, history of A-list

0:04

dural fistulas, um, the vascular variant.

0:08

She presents to neuro IR.

0:09

So A-list dural fistulas should really

0:10

sort of raise a little bit of concern.

0:12

So she gets her diagnosis with a large

0:15

angiogram, and of course, a vascular variant.

0:19

A little tricky here.

0:20

So nine days later, you know,

0:22

she was discharged after being placed on

0:24

aspirin and clopidogrel for

0:26

her sagittal sinus stent placement.

0:29

And she comes in with a pulsatile

0:31

mass in her right groin.

0:32

Hmm.

0:33

What could that be?

0:34

I'm sure if you would have put a stethoscope

0:36

on it you would probably hear a little

0:38

bruise rather and feel a little thrill.

0:40

So what do you see here?

0:42

Well, what you see here is a pseudoaneurysm.

0:45

Again.

0:45

Again.

0:47

And young appearance, which, you know,

0:50

is something that we really want to consider

0:52

when we see these guys show up.

0:55

So what should you do to treat the pseudoaneurysm?

0:58

Thrombin injection?

0:59

That's certainly a consideration.

1:02

So this young lady underwent ultrasound

1:04

guided injection of thrombin, but she

1:05

developed a pretty aggressive allergic

1:07

reaction, and the procedure was stopped.

1:09

I wonder why.

1:10

So what can you do for the patient now?

1:12

Well, looking at the common femoral artery, looking

1:15

at the neck, okay, alright, we can work with this.

1:18

So let's perform ultrasound-guided compression.

1:20

So here we see a nice long view through

1:22

the vessel, and what we decide that we

1:25

want to do is compress this, and actually

1:27

reduce it so that there's only flow in here.

1:30

So we do that, and what do we accomplish?

1:33

Thrombosis of the pseudoaneurysm.

1:37

If you're into high fives, now would

1:39

be an appropriate time to do so.

1:41

So hemostasis was achieved, and the procedure

1:42

was completed with no further complications.

1:44

Crisis averted.

1:47

So, in summary, a pseudoaneurysm is a collection

1:49

of blood occurring between one or two of the outer

1:51

layers of the artery that can present with what?

1:53

Pain, swelling, a pulsatile

1:55

mass with thrill or murmur.

1:58

An ultrasound, grayscale sonography,

2:00

can actually show a pseudoaneurysm that has this

2:02

sort of pulsatile anechoic saccular

2:05

lesion that can have variable echogenicity

2:07

on grayscale sonography, but it has that

2:09

yin and yang appearance on color Doppler

2:12

with that sort of turbulent, swirling,

2:13

flow. So, how do you manage it?

2:17

Maybe ultrasound-guided compression,

2:20

maybe observation, maybe surgical repair.

2:24

So, you consider.