Catastrophic Pseudoaneurysm: A Rare Post-Angiography Complication

Introduction: Angiography is a standard procedure for anatomical evaluation of vascular disease with risks including bleeding, infection, and vessel damage. We describe a case of a patient who suffered a devastating arterial pseudoaneurysm with resultant abdominal compartment syndrome following routine angiography.


Description: A 76-year-old female presented to the hospital for routine cerebrovascular angiography for internal carotid and vertebral artery stenosis after noticing lightheadedness, ataxia, and presyncope. Interventional angiography utilized a femoral approach to identify and repair the known stenosis with no residual disease post-procedure. Following the procedure, the patient had hypotension attributed to anti-hypertensive pharmacotherapy and procedural sedation. Despite fluid resuscitation, the patient had progressive hypotension, new abdominal distension, and urinary fullness. Given recent instrumentation, concern for arterial hematoma prompted a CT angiogram which revealed a right femoral pseudoaneurysm with active extravasation and large intrapelvic hemorrhage. The patient developed severe lactic acidosis and persistent abdominal distension concerning for abdominal compartment syndrome. Despite vasopressor support, massive transfusion protocol, surgical decompression, and emergent pseudoaneurysm repair, the patient suffered multisystem organ failure and cardiac arrest without return of spontaneous circulation.


Discussion: Angiography, a procedure for vessel analysis, has risks of bleeding, infection, and damage to the vessel. Although pseudoaneurysm formation post-catheterization is common, rupture of the vessel defect is rare with no prevalence documented in medical literature. Depending on the location of pseudoaneurysm formation, rupture of the vessel can cause increased abdominal pressure that can lead to abdominal compartment syndrome (ACS). ACS is a surgical emergency that manifests as a rapid drop in hemoglobin, decrease in urine output, and abdominal swelling. ACS has a mortality rate up to 100% if not diagnosed and if left untreated. The high mortality rate of ACS requires clinicians to be aware of the post-angiography complication in patients with decreasing urine output, hemodynamic compromise or abdominal distension.