Iatrogenic Subclavian Artery Pseudoaneurysms

Abstract

Iatrogenic subclavian artery pseudoaneurysms developed in two patients after inadvertent introducer sheath placement into the artery during attempted subclavian vein cannulation using Seldinger's technique. Such iatrogenic subclavian artery pseudoaneurysms are quite rare, but they may become more common with the increasing use of invasive monitoring and diagnostic techniques. Both cases involved patients in hypovolemic shock at the time of attempted subclavian vein cannulation. Their injuries were confirmed by preoperative arteriography, and primary arterial repair was successful in each. Based on our experience, we make the following recommendations: 1) subclavian vein cannulation with large-bore catheters should be avoided in hypovolemic patients; 2) suspected cases of iatrogenic arterial injury should be evaluated arteriographically; and 3) primary repair to prevent subsequent thrombosis, rupture, or embolization should be performed after confirmation of the injury.