Giant Bleeding Pseudo-aneurysm of left Sub-clavian Artery Complicating Neurologic Impairment: Management Challenges (Case Report)

Abstract

Subclavian artery pseudoaneurysms are rare and occur mostly as a consequence of an inadvertent arterial puncture during central venous catheterization, endovascular therapeutic procedures or after penetrating or blunt trauma. They usually have a late clinical presentation, with pain, swelling or other compressive symptoms. We present a 40-year old man farmer who presented to our service with prior 14 days and 12 days history of left chest upper chest swelling and inability to use the left upper limb respectively, all on account of injury. He went on a night alcohol binge, got drunk and while getting to his sitting room slipped and fell on a nearby glass center table. He had a deep cut on the left upper anterior chest wall. There was immediate profuse spurting bleeding with estimated blood loss of 800 ml. After delay in definitive treatment due to financial constraint the aneurysm increased in size, ruptured and rebled profusely leading to syncope. He was managed by Doppler ultrasound, median sternotomy and subclavian artery exploration to achieve proximal and distal vascular control. Sac was entered into via an infraclavicular transverse incision, heamatoma manually evacuated, bleeding site isolated and secured. He received 5 units of blood. Postoperative course was uneventful as he was managed with analgesics, antibiotics, haematinics and physiotherapy. Power in the upper limb has improved to 3 around the shoulder, 2 around the elbow and 1 around the wrist.