Current management of inguinal false aneurysms.

False aneurysms are formed as a result of bleeding causing a hematoma to compress the surrounding tissue. The majority of false aneurysms presenting to the vascular surgeon are caused by iatrogenic injury to an artery. Although anastomotic failure occurs, a much higher number is caused by bleeding from puncture sites after percutaneous intervention. Anticoagulative medication, low patelet counts and severely calcified vessels increase the risk of forming a false aneurysm. Experienced specialists may make the diagnosis from physical examination, but ultrasound imaging is almost always needed in order to decide for a treatment strategy. Small aneurysms with a diameter of less than 3 cm tend to thrombose spontaneously except in patients in anticoagulative treatment. Treatment options include ultrasound guided compression, which may be effective in a high proportion of patients who are not in anti-coagulative treatment, but may require prolonged compression and cause pain and discomfort. Duplex guided injection of thrombin or glue requires less time of compression and can be effective in patient s on antiocoagulative treatment, but may cause spillage of adhesive material into the crural vessels. Endovascular treatment with coils or covered stent grafts have proven useful in infected ilio-femoral false aneurysms. Open surgical repair may be the best treatment in the setting of imminent rupture, massive hematoma and skin necrosis. We present three patient cases treated with open surgery, endovascular coiling, and thrombin injection.