Morphofunctional Stratification of Traumatic Pseudoaneurysms of Peripheral Arteries, Including Those Associated with Arteriovenous Fistulas: a Diagnostic Algorithm
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction . Traumatic peripheral artery pseudoaneurysms may manifest with a delay, while associated arteriovenous fistulas may remain unrecognized. Morphofunctional assessment is necessary for choosing the appropriate treatment strategy. Objective . To evaluate the diagnostic capabilities and complementary role of imaging modalities in isolated traumatic pseudoaneurysms of the peripheral arteries and in their combination with arteriovenous fistulas and, on this basis, to develop an algorithm for the morphofunctional stratification of vascular lesions to justify the choice of open, endovascular, or hybrid surgical strategy. Materials and Methods . The study included 195 men. Retrospective analysis and prospective follow-up were performed. Specialized duplex ultrasound (DUS) was performed according to a standardized angiological protocol , as well as CT angiography, and, when indicated, selective angiography. Results . Isolated pseudoaneurysm was diagnosed in 110 (56.4 %) patients; and its combination with arteriovenous fistula – in 85 (43.6 %). Initial DUS detected pseudoaneurysm in 136 of 195 (69.7 %) patients, while repeat specialized DUS detected it in 185 (94.9 %) patients, increasing the detection rate by 25.2 percentage points (p<0.001). CT angiography also verified pseudoaneurysm in 185 (94.9 %) patients and more frequently detected distal arterial changes than DUS: 44 (22.6 %) versus 38 (19.5 %) cases (p=0.031). Among 85 patients with combined lesions, specialized DUS detected arteriovenous shunting in 48 (56.5 %) cases. Selective angiography clarified lesion anatomy in 6 of 128 (4.7 %) patients; in 112 (87.5 %) cases, examinations proceeded to endovascular or hybrid intervention. Conclusion . Specialized DUS, CT angiography, and selective angiography have complementary diagnostic capabilities in isolated traumatic peripheral artery pseudoaneurysms and in their combination with arteriovenous fistulas. Their sequential use provides comprehensive anatomical and hemodynamic characterization of the vascular lesion and serves as basis for an algorithm for selecting open, endovascular, or hybrid surgical strategy.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7220701664