Abstract
AimBrief case report of the treatment of a large axillary artery pseudoaneurysm after a pacemaker using a left brachial cutdown and a retrograde delivery of a covered stent using ultrasound and fluoroscopic guidance. The patient's renal function precluded the use of contrast materials.Case ReportA 77 years old man presenting with acute renal failure and haemoglobin decrease arrived with an expanding pseudoaneurysm of the left axillary artery from a pacemaker placement. Considering the site of the lesion and patient's comorbidities, under echographic control, a Hemobahn® stent-graft was placed; fluoroscopy assisted manipulation of guidewires and sheaths into the aortic arch. The procedure was successfully ended without any complications. At 8 months the stent graft was still patent.ConclusionUltrasound guidance may represent an alternative for pseudo-aneurysm exclusion without any use of contrast medium, especially in those patient where lesions are easily detectable using ultrasonography and when comorbidities contraindicate aggressive surgical or angiographic approach.
Highlights
A pseudoaneurysm is a rare but serious complication after pace-maker placement procedures
Ultrasound guidance may represent an alternative for pseudo-aneurysm exclusion without any use of contrast medium, especially in those patient where lesions are detectable using ultrasonography and when comorbidities contraindicate aggressive surgical or angiographic approach
Endovascular procedures currently represent a preferred treatment for these lesions, as they are less invasive than surgical approach
Summary
A pseudoaneurysm is a rare but serious complication after pace-maker placement procedures. Endovascular procedures currently represent a preferred treatment for these lesions, as they are less invasive than surgical approach. Endovascular repair, implicates the use of a iodine contrast medium, which may represent a contraindication for patients with a severe renal impairment. We report here the first case of endovascular exclusion of an axillary artery pseudoaneurysm under ultrasound guidance, without any use of contrast medium. Case presentation A 77 years old man was admitted to our hospital for a sudden pain under his left clavicle, with a large palpable pulsing mass. Two weeks before, he had undergone a pacemaker positioning procedure to manage an arrhythmia
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