Subclavian Artery Pseudoaneurysm Research Articles

Stent-Graft Repair of Iatrogenic Subclavian Artery Pseudoaneurysm with Planned Exclusion of the Vertebral Artery

Stent-Graft Repair of Iatrogenic Subclavian Artery Pseudoaneurysm with Planned Exclusion of the Vertebral Artery

Stent-Graft Repair of Iatrogenic Subclavian Artery Pseudoaneurysm with Planned Exclusion of the Vertebral Artery

Iatrogenic subclavian artery pseudoaneurysm is an uncommon complication secondary to central line placement. Therapeutic options include conservative therapy, direct surgical repair and minimal invasive techniques such as endovascular exclusion by covered stents, coiling, transstent coiling and ultrasound guided percutaneous thrombin injection (UPTI).We present a case report of subclavian artery pseudoaneurysm as a result of puncture of the internal jugular vein treated by covered stent with planned occlusion of vertebral artery.Although many publications have addressed the concept of endovascular repair, to the best of our knowledge, planned overstenting the vertebral artery by endograft placement for exclusion of subclavian artery pseudoaneurysm has been described only once previously.

Subclavian artery pseudoaneurysm: a rare and serious complication of central venous catheterization in an infant

Serious complications of central venous access occur in 0.4-9.9% of patients undergoing attempted central venepuncture. We report an unusual case of an 18-month-old infant in whom a right subclavian artery pseudoaneurysm developed rapidly after attempted subclavian vein catheterization without US guidance failed.

Covered Stent Application of a Repeatedly Regrowing Iatrogenic Subclavian Artery Pseudoaneurysm at the Origin of the Vertebral Artery

Formation of an iatrogenic subclavian artery pseudoaneurysm while attempting central venous access through the internal jugular vein is relatively uncommon. However, management of a subclavian artery pseudoaneurysm remains a challenge because of its growing tendency and its relation to the origin of the vertebral artery (VA). We report a strategy for using a covered stent as for the endovascular treatment of a patient with a repeatedly regrowing subclavian artery pseudoaneurysm at the origin of the VA.

Brachial plexus palsy due to subclavian artery pseudo aneurysm from internal jugular cannulation

Internal jugular vein is the preferred route for central venous cannulation because of easy accessibility and high success rate. Arterial puncture is the most common complication, the reported incidence being 9.3%. However, brachial plexus palsy following arterial puncture is a rare complication of this procedure. We report a case of brachial plexus palsy due to compression by right subclavian pseudoaneurysm as a result of internal jugular vein cannulation in chronic renal failure patient.

Subclavian Artery Occlusion and Pseudoaneurysm Caused by Lung Apex Mucormycosis: Successful Treatment with Transcatheter Embolization

Subclavian artery pseudoaneurysm and occlusion in young patients are usually post-traumatic. We report the case of a 33-year-old diabetic woman with subclavian artery occlusion and pseudoaneurysm formation caused by pulmonary mucormycosis infection. The patient presented with diabetic ketoacidosis, Horner's syndrome, and absent left arm pulses. A cystic lesion of the left lung apex was found by imaging, was surgically resected, and was histologically diagnosed as mucormycosis infection. Magnetic resonance angiography depicted a left subclavian artery pseudoaneurysm and occlusion adjacent to the mucormycosis lesion. To protect against thromboembolic complications and rupture, the pseudoaneurysm was embolized with coils. The patient is clinically well 1 year after the intervention with no perfusion of the pseudoaneurysm.

Endovascular Exclusion Of Subclavian Artery Pseudoaneurysm

Subclavian artery pseudoaneurysms are typically a rare occurrence commonly caused by iatrogenic injury and trauma. We describe an endovascular approach employing a brachiofemoral through-wire technique for the treatment of a left subclavian artery pseudoaneurysm in the presence of a hostile aortic arch and great vessel anatomy.

Subclavian artery pseudoaneurysm in Behcet’s disease

Behcet's disease (BD) is an autoimmune, multisystemic, and chronic inflammatory disease. Although it affects all systems, involvement of the vascular system is of vital importance. Pseudoaneurysm ruptures in the arteries are the major causes of sudden deaths in BD. Although pseudoaneurysms in aorta and pulmonary arteries are rare, it is even more rare in the subclavian arteries. In our case, a pulsatile mass in the right clavicular area was determined to be associated with BD and this case is presented because subclavian artery pseudoaneurysm is seen rarely in BD.

Iatrogenic subclavian artery pseudoaneurysm causing airway compromise: treatment with percutaneous thrombin injection

Central venous cannulation is an increasingly common diagnostic and therapeutic procedure in modern medical practise. Inadvertent iatrogenic injury to an adjacent major artery during attempted central venous cannulation is an uncommon but potentially lethal complication. If injury leads to pseudoaneurysm formation, complications may arise from mass effect, embolism, or even rupture with continued hemorrhage. Traditional surgical repair of these lesions is often difficult, especially if access within the thorax is required in patients at high risk. We present a case report of successful management of a large subclavian artery pseudoaneurysm with the new approach of percutaneous thrombin injection.

Traumatic Pseudoaneurysm of the Subclavian Artery Causing Pain and Presenting Repetitive Distal Embolization Events -A case report-

A pseudoaneurysm of the subclavian artery is an uncommon complication of a blunt or penetrating trauma to the shoulder. As with aneurysms in other locations, it may result in rupture, thrombosis or embolization. Because these vascular injuries are missed initially, considerable morbidity can ensue from complications. Early diagnosis followed by resection or exclusion is advocated. Herein is report a rare case of a traumatic pseudoaneurysm of the left subclavian artery, with repetitive distal embolization events, in a 59-year-old woman. She was admitted with pain in the left forearm of 3 months duration. Her history revealed a blunt trauma to the left shoulder 3 years previously, with pain in the left shoulder ever since. Although the initial angiography showed a left subclavian aneurysm with brachial arterial embolization, a diagnosis of brachial artery occlusion was initially made. After repetitive events of distal embolization, the last angiography confirmed a subclavian pseudoaneurysm, presumably resulting from the blunt trauma to the shoulder 3 years earlier. The pseudoaneurysm, containing a thrombus, was thought to be the source of the artery-to-artery embolization.

Endovascular stent-graft applications in latrogenic vascular injuries.

To report the results of covered stent applications in iatrogenic vascular injuries. We report 17 patients (11 men, 6 women; age range 20-59 years, mean age 40 years) who underwent repair of different iatrogenic vascular lesions by means of endovascular covered stents. The patient population consisted of 8 femoral arteriovenous fistulae, 4 common femoral artery pseudoaneurysms, 1 subclavian artery pseudoaneurysm, 1 abdominal aortic aneurysm, 1 iliac artery perforation, 2 porto-biliary fistulae that developed during TIPS procedure. Balloon-expandable stent-grafts were used in all patients except one. Control studies were performed with angiography. Technical success was achieved in all 17 patients. The mean clinical follow-up period for all 17 patients was 8 months. There were no signs of stent migration or leaks in the control studies. Only one patient developed a hemodynamically insignificant stenosis at the proximal end of the stent. There have been no stent deformations or related complications during the follow-up period. Our short-term results suggest that endovascular treatment is a low-risk procedure and appears less invasive than surgery for the treatment of different types of iatrogenic vascular injuries. Intermediate and long-term results are not available.

Melioidosis presenting as an infected intrathoracic subclavian artery pseudoaneurysm treated with femoral vein interposition graft

We present the first case of in situ replacement of an infected subclavian artery using superficial femoral vein and the fourth reported case of an infected arterial pseudoaneurysm caused by pseudomonas pseudomallei. Sepsis and hoarseness developed in a 58-year-old man after recent travel to Borneo, Indonesia. Indirect laryngoscopy revealed a paralyzed right vocal cord. Computed tomography and arteriography revealed a 6.5-cm pseudoaneurysm of the proximal right subclavian artery. Blood cultures grew pseudomonas pseudomallei. An abnormal cardiac stress test prompted a coronary angiography, which revealed severe coronary artery disease.The patient underwent coronary artery bypass and in situ replacement of the infected subclavian artery pseudoaneurysm with a superficial femoral vein, along with placement of a pectoralis major muscle flap to cover the vein graft. Operative cultures of the pseudoaneurysm grew pseudomonas pseudomallei. The patient was treated with a 6-week course of intravenous ceftazidime and oral doxycycline and then continued on oral amoxicillin-clavulanate. One week after discontinuing intravenous antibiotics, the patient presented to the emergency department with a rapidly expanding, pulsatile mass in the right supraclavicular space. He was taken emergently to the operating room. After hypothermic circulatory arrest was accomplished, the disrupted vein graft and aneurysm cavity were resected and the subclavian artery was oversewn proximally and distally. Parenteral ceftazidime was continued for 3 months and oral amoxicillin-clavulanate (augmentin) was continued indefinitely. There was no evidence of infection clinically or by computed tomographic scan 2 years later. Although autogenous vein replacement of infected arteries and grafts may be successful in the majority of cases, this strategy should probably be avoided when particularly virulent bacteria such as the organism in this case are present.

Successful Management of Subclavian Artery Pseudoaneurysm After Subclavian Vein Cannulation: Report of a Case

Subclavian artery pseudoaneurysm after subclavian vein cannulation is not usually seen. A 19-year-old man with left traumatic chylothorax was managed using central. Venous cannulation over his left subclavian vein for administration of total parental nutrition. Severe left shoulder pain, hoarseness, left ptosis, left upper limb muscle power weakness, and left-hand numbness were disclosed gradually. Subsequent arch aortography revealed a left subclavian artery pseudoaneurysm. Endovascular stented graft repair was performed, and all the symptoms and signs induced by the pseudoaneurysm subsided gradually. In this study, we present the chinical characteristics, discuss this unusual complications, and review the literature concerning diagnosis and management of pseudoaneurysm of the subclavian artery.

Percutaneous obliteration of an Iatrogenic pseudoaneurysm of the right subclavian artery with a PTFE-covered stent-graft.

Percutaneous obliteration of an Iatrogenic pseudoaneurysm of the right subclavian artery with a PTFE-covered stent-graft.

Treatment of Subclavian Artery Pseudoaneurysm with Use of US-guided Percutaneous Thrombin Injection

Treatment of Subclavian Artery Pseudoaneurysm with Use of US-guided Percutaneous Thrombin Injection

Thrombin injection for treating a subclavian artery pseudoaneurysm

Accidental arterial punctures while attempting central venous access through the internal jugular vein are uncommon (0.1% to 0.4%). 1 Sneff M Central venous catheters. in: 2nd ed. Intensive care medicine. : Little Brown, Boston1991: 17-37 Google Scholar , 2 Tyden H Cannulation of the internal jugular vein–500 cases. Acta Anaesthesiol Scand. 1982; 26: 485-488 Crossref PubMed Scopus (37) Google Scholar Though rare, the carotid artery is the most common artery penetrated when internal jugular vein access is attempted, and inadvertent subclavian artery puncture is even rarer. 1 Sneff M Central venous catheters. in: 2nd ed. Intensive care medicine. : Little Brown, Boston1991: 17-37 Google Scholar , 2 Tyden H Cannulation of the internal jugular vein–500 cases. Acta Anaesthesiol Scand. 1982; 26: 485-488 Crossref PubMed Scopus (37) Google Scholar , 3 Shield 3rd, CF Richardson JD Buckley CJ Hagood Jr, CO Pseudoaneurysm of the brachiocephalic arteries: complication of percutaneous internal jugular vein catheterization. Surgery. 1975; 78: 190-194 PubMed Google Scholar , 4 Pastores S Marin ML Veith FJ Bakal CW Kvetan V Endovascular stented graft repair of a pseudoaneurysm of the subclavian artery caused by percutaneous internal jugular vein cannulation: case report. Am J Crit Care. 1995; 4: 472-475 PubMed Google Scholar Pseudoaneurysm formation, arterial venous fistula, and arterial dissection represent potentially serious complications of inadvertent arterial puncture. Iatrogenic pseudoaneurysms, particularly of the femoral artery (a common site of pseudoaneurysms because the femoral artery is often accessed for diagnostic procedures), can be treated with external compression and ultrasound-guided compression (UGC) or UGC alone. Successful external compression of a subclavian artery pseudoaneurysm is difficult to accomplish because of the depth of the artery and the overlying position of the clavicle. These factors often limit access to the neck of the pseudoaneurysm and, therefore, make UGC difficult. The lack of noninvasive access to the subclavian artery for compressive techniques often means that the patient will require surgery for the pseudoaneurysm repair (a thoracotomy is typically required to obtain proximal control of the artery). Endovascular approaches have been developed and are increasingly used to treat inaccessible pseudoaneurysms.

Complementary Surgical/Interventional Techniques for Nonresective Management of “Inoperable” Aneurysms: A Second Look

Induced thrombosis ("nonresective" therapy) of aortic aneurysms by distal arterial ligation, coil/wire embolization, and extraanatomic bypass was devalued by anecdotal reports emerging during the mid-1980s. Nevertheless, we have recently found the technique to be life-saving in occasional cases and worth revisiting. Since 1990, standard aortic aneurysm repair has been performed in 231 patients (99.1% survival), endovascular aortic aneurysm repair in 6 patients (83.3% survival), and combined surgical/interventional "nonresective" repair of a variety of aneurysms in 10 patients (100% survival). Mean age of the group was 67.9 years. Repair was performed for aortoiliac aneurysms (4), common iliac aneurysms (3), internal iliac aneurysms (2), and a large proximal subclavian artery pseudoaneurysm (1). Four of the patients had been explored and declared to be "inoperable" (retroperitoneal fibrosis) prior to transfer to the Columbia-Presbyterian Medical Center. All patients survived. Aneurysm rupture has not occurred in any patient, but one patient with a presumably thrombosed subclavian pseudoaneurysm presented 26 months postcoil-induced thrombosis with progressive aneurysm enlargement due to incomplete aneurysm thrombosis and required repair using circulatory arrest. Eight of the patients remain alive (80%) at a mean follow-up of 40.3 months (range 14-88 months). Two patients died of malignancy (30 months) and cardiac disease (15 months). It is concluded that combined surgical/interventional techniques can be life-saving in the rare instances when conventional or endovascular aneurysm repair is not advisable but that complete aneurysm thrombosis is essential and occasionally difficult to achieve. Since small proximal portions of the aneurysm may remain patent and not be visualized on magnetic resonance imaging (MRI) or computed tomography (CT) scans, contrast angiographic documentation of complete aneurysm thrombosis is essential prior to hospital discharge and close follow-up is necessary to ascertain long-term adequacy of the repair. Incomplete thrombosis is suspected as a major factor in earlier reports of aneurysm rupture after seemingly successful nonresective therapy.

Brachial plexus compression due to subclavian pseudoaneurysm from cannulation of jugular vein hemodialysis catheter

Jugular venous cannulation is generally safer than subclavian cannulation. The traumatic complications associated with jugular vein hemodialysis catheters are rare. A jugular vein, therefore, has become the preferred site for hemodialysis catheter insertion. We describe the first case of brachial plexus compression attributable to delayed recognition of a right subclavian pseudoaneurysm as a complication of jugular venous cannulation of hemodialysis catheter. We advocate that any neck swelling, new bruit, and the symptoms of brachial plexopathy after jugular venous cannulation warrant an intensive investigation to exclude arterial injury. Because delayed diagnosis may lead to a worsened prognosis in patients with brachial plexus palsy, physicians should exercise vigilance to detect and manage early the potentially serious and fatal complications of subclavian artery pseudoaneurysm and brachial nerve injury. (Am J Kidney Dis 1998 Apr;31(4):694-7)

Subclavian artery pseudoaneurysm in type IV Ehlers-Danlos Syndrome

We report case of a subclavian artery pseudoaneurysm in a patient with type IV Ehlers-Danlos Syndrome. A 16-year-old boy underwent successful repair of a subclavian artery pseudoaneurysm that occurred after a cervical hyperextension injury. Subsequent workup included skin biopsy and fibroblast culture, which were consistent with a diagnosis of type IV Ehlers-Danlos Syndrome. This condition is a dominantly inherited connective tissue disorder, which in this patient was found to be caused by a spontaneous point mutation in the COL3A1 gene that encodes the chains of type III procollagen. The clinical, genetic, and molecular characteristics of type IV Ehlers-Danlos Syndrome are briefly reviewed. (J Vasc Surg 1998;27:549-51.)

Pseudo-aneurisma de artéria subclávia pós fratura de clavícula: relato de caso

Os autores descrevem a formacao de um pseudo-aneurisma de arteria subclavia esquerda apos trauma contuso seguido de fratura de clavicula esquerda. Comentarios e uma breve revisao da literatura sao mencionados