关键词: 腹主动脉假性动脉瘤, 病因与分类, 感染性假性腹主动脉瘤, 非感染性假性腹主动脉瘤, 腔内治疗

Abstract: Abdominal aortic pseudoaneurysm (AAPS) is a rare abdominal aortic disease associated with a high risk of rupture and mortality. The etiology of AAPS is complex and includes infectious, immune-mediated, iatrogenic, traumatic, and digestive factors. The key characteristic of AAPS is the rupture of the entire arterial wall, resulting in the formation of a pseudoaneurysm, with pathological features lacking the normal trilaminar arterial structure. Infectious AAPS accounts for approximately 1% of cases, with pathogens such as Staphylococcus aureus and Mycobacterium tuberculosis. Non-infectious AAPS includes immune-related cases associated with large-vessel vasculitis or Behçet’s disease, iatrogenic cases caused by endovascular or open surgical trauma, and traumatic or digestive cases resulting from external injury or enzymatic erosion, respectively. The diagnosis of AAPS primarily relies on imaging methods. Ultrasound can identify the characteristic “ying-yang sign” of blood flow, while computed tomography angiography (CTA) is the preferred modality for diagnosis and assessment of lesion extent. Magnetic resonance angiography (MRA) provides supplementary information in selected cases. The diagnosis of different types of AAPS requires careful consideration of etiology and clinical manifestations. For instance, infectious AAPS may present with sepsis, while digestive AAPS often results from gastrointestinal perforation or pancreatitis complications. Due to the high risk of rupture and mortality, timely intervention is essential for AAPS. Surgery remains the mainstay of treatment, swith options including open surgery, endovascular repair, and hybrid procedures. The management of infectious AAPS emphasizes broad-spectrum antibiotic therapy combined with debridement and vascular reconstruction, whereas non-infectious AAPS is more commonly treated with endovascular repair. Open surgery is preferred for complex lesions or cases contraindicated for endovascular treatment, while hybrid surgery combines the advantages of both open and endovascular techniques. Given the rarity of AAPS and the lack of high-quality evidence, treatment strategies must be individualized. Future advancements in anti-infective materials, multi-branched stent-grafts, and 3D printing technologies are expected to further improve the diagnosis and treatment outcomes for AAPS.

Key words: abdominal aortic pseudoaneurysm(AAPS), etiology and classification, infected AAPS, non-infected AAPS, endovascular repair