Upper limb monoparesis: Imaging evaluation and endovascular management of iatrogenic pseudoaneurysm

Abstract

Background: Cannulation of the internal jugular vein is a common procedure performed in the hospital setting. The development of false aneurysms, emboli, fistulae and hematomas are common complications due to vascular interventions. False aneurysms, or pseudoaneurysms, constitute the majority of these iatrogenic complications. Pseudoaneurysms can be life-threatening and are considered a surgical emergency due to their high relative risk of rupture and bleeding. Case Presentation: This is a case of a 29-year-old female, who presented with symptoms of delayed paralysis of brachial plexus due to transverse cervical artery pseudoaneurysm following iatrogenic trauma. Discussion: The brachial plexus is the primary source of peripheral nervous innervation to the upper extremity, associated muscles of the upper chest and cutaneous supply to the skin and hand. In the region of the thoracic outlet, the brachial plexus comes in close contact with major subclavian vessels supplying the upper extremity. On account of the anatomic proximity between the brachial plexus and transverse cervical artery in the thoracic outlet, a pseudoaneurysm or hematoma in this region can cause compression of the neuroplexus and lead to the gradually progressive neurological deficit over days to weeks as opposed direct penetrating injuries. If left untreated, brachial plexopathy has an unfavorable prognosis Endovascular therapy and surgical management play a crucial role in their treatment. Owing to increased procedural efficacy and its less invasive nature, endovascular repair is being more widely accepted in recent years. Since the exposure of the subclavian artery and difficult vascular control in open surgery poses a challenge in the management of pseudoaneurysms, endovascular treatment is the preferred method of treatment.