Can pseudoaneurysm occur in veins?

Can Pseudoaneurysms Occur in Veins? A Rare but Real Risk

When we think of pseudoaneurysms, arteries—especially the femoral artery—typically come to mind. But while rare, veins can also develop pseudoaneurysms, particularly after invasive procedures involving vascular access.

A striking example is the case of a 68-year-old woman who underwent catheter ablation for atrial fibrillation at an outside facility. Post-procedure, she developed a complication that’s seldom discussed: a common femoral vein pseudoaneurysm. This rare condition occurred after failed manual compression at the catheter insertion site—a standard step meant to prevent bleeding, but which can sometimes backfire if excessive or improperly applied.

Unlike true aneurysms, pseudoaneurysms involve a tear in the vessel wall, allowing blood to leak and collect in a surrounding pocket, contained only by the outer layers of tissue. While far more common in arteries due to higher pressure, venous pseudoaneurysms do happen—especially in large veins like the femoral vein when subjected to trauma during catheterization.

Symptoms can include localized pain, swelling, or a pulsatile mass in the groin. In this patient, timely imaging confirmed the diagnosis, and appropriate intervention was initiated. Given the rise in endovascular procedures—from ablations to stent placements—awareness of such complications, even the uncommon ones, is critical.

This case reminds us that vascular risks aren’t limited to arteries. Clinicians must remain vigilant, especially when managing post-procedural patients with unexplained discomfort near access sites. Proper technique, careful monitoring, and understanding the full spectrum of complications—including rare venous pseudoaneurysms—are essential for patient safety.