Subclavian Artery Pseudoaneurysm Research Articles

Complicated right subclavian artery pseudoaneurysm after central venipuncture

Life-threatening complications of central venipuncture are rare. We report an unusual case of a patient in whom a large right subclavian pseudoaneurysm developed, causing pressure necrosis of the membranous trachea and esophagus, after right internal jugular vein cannulation. The patient underwent oversewing of the proximal and distal ends of the subclavian artery and primary tracheal repair. An esophageal leak that presented on the sixth postoperative day was treated by primary suture repair with proximal and distal diversion.

Blunt thoracic aortic injury in children

Thoracic aortic injury (TAI) in children secondary to blunt chest trauma is rare and less well documented than TAI in adults. To further establishe the incidence and radiographic manifestations of this severe injury, we reviewed our experimence with TAI in children over an 8-year period. We performed a computer search from the Trauma Registry at our level I trauma center for all cases of TAI among patients 16 years of age or younger who were admitted after sustaining blunt chest trauma between August 1984 and September 1992. We reviewed our records of all thoracic aortograms performed on children for blunt trauma during this same time period. Indication for angiography was determined by review of chest radiographs and medical records of all patients who underwent thoracic aortography. We reviewed medical records and all available chest radiographs, computed tomography (CT) examinations, and thoracic aortograms of children diagnosed with TAI. Of 308 children admitted with blunt chest trauma, 26 (8.4%) underwent angiography to exclude aortic or great vessel injury. Of these 26 patients, three (11.5%) were diagnosed with TAI, and one patient demonstrated a traumatic pseudoaneurysm of the proximal left subclavian artery. The incidence of TAI among children who sustained blunt chest trauma was 1.0% in our series. All three patients with TAI in our series were male, ages 10–12 (mean: 11 years). Chest radiographs on two of the patients with TAI revealed mediastinal widening, ill-defined aortic outline, shift of the trachea and nasogastric tube, and depression of the left main stem bronchus. The chest radiograph in one patient with TAI was technically inadequate. CT demonstrated abnormalities in two patients. Angiographic findings were similar to those seen in adults. TAI in children is rare, occurring in 1% of children sustaining blunt chest trauma in our series. Our findings support previous reports that the plain film, CT, and angiographic findings with this injury resemble those found in adults.

Use of Color Doppler Ultrasound in the Diagnosis and Treatment of Iatrogenic Subclavian Artery Pseudoaneurysm

Pseudoaneurysms resulting from inadvertent cannulation of the subclavian artery are rare, with only three prior cases reported in the English literature. Generally, they have required surgical correction. We present a case of a right subclavian artery pseudoaneurysm resulting from an unsuccessful attempt at cannulation of the right internal jugular vein by the middle approach. In this patient, successful closure of the pseudoaneurysm was accomplished with prolonged manual compression guided by vascular ultrasound and Doppler color flow imaging.

The Recalcitrant Subclavian Pseudoaneurysm: A Case Report

A case of pseudoaneurysm of the left subclavian artery is presented. It demonstrates not only the difficulties facing the surgeon and radiologist in the management of this rare condition, but also how interventional radiology and surgery can be used in tandem to approach such a complex vascular problem.

Iatrogenic Subclavian Artery Pseudoaneurysms

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.