Successful endovascular repair of a subclavian artery pseudoaneurysm

Serious complications of central venous access occur in 0.4–9.9% of patients undergoing attempted central venepuncture [1]. Potential complications include failure to locate or cannulate the vein, puncture of the subclavian artery, misplacement of the catheter, pneumothorax, mediastinal haematoma, haemothorax and injury to adjacent nerves [2]. Pseudoaneurysm formaFig. 1. Bleeding bullous lesion eroding the skin under the right tion of the great vessels and the right subclavian artery clavicle. is rare in patients undergoing central venepuncture [3]. The evolution of pseudoaneurysm is continued expansion and eventually rupture; therefore, pseudoaneursion, it enlarged rapidly causing erosion of the skin ysms should be repaired to prevent inevitable rupture. and blood leakage. The auscultation of the lesion Endovascular stent grafts offer an alternative approach revealed a pansystolic murmur around the lesion radito standard treatments for a variety of vascular pathoating to the sternum. After initial thoracic aortography logies including aneurysm. via the right common femoral artery, selective angiogWe observed a case of a large subclavian artery raphy of the right subclavian artery was performed pseudoaneurysm that caused pressure necrosis of the which showed an aneurysm, approximately 4 × 5 cm skin. The pseudoaneurysm occurred after subclavian in size, originating from the upper contour of the right vein catheterization for haemodialysis access and was subclavian artery and extending anteriorly and supersuccessfully repaired using the endovascular approach. iorly (Figure 2). The clavicle provoked a depression of the aneurysm resulting in a bilobulated shape. The aneurysm had a neck of ~1.5–2 cm. Total occlusion Case of the right subclavian vein was observed by venography. As the aneurysm was false, repair was obviously A 21-year-old male with a history of dialysis for 2 necessary and the surgical approach risky, since the months via a right subclavian vein catheter was referred aneurysm had eroded the skin and there was a high to our hospital because of a bleeding bullous lesion risk of aneurysm rupture during dissection, therefore eroding the skin underneath the right clavicle (Figure an endovascular repair was chosen. At first a 0.035 in. 1). The patient was unable to walk because of sequela hydrophylic exchange guidewire (Terumo Europe of polio at the age of 1 year. The catheter was removed N.V., Belgium) was passed through the lesion. A 2 weeks after implantation because of thrombosis of 28 mm balloon expandable PTFE-covered Jostent the subclavian vein diagnosed by Doppler ultrasonoPeripheral Stent Graft (Jomed Implantate GmbH, graphy. The skin lesion appeared 1 week before admisRangendingen, Germany) was then loaded onto a 6 × 30 mm balloon and introduced over the guidewire to the right subclavian artery against the neck of the Correspondence and offprint requests to: Yrd. Doç. Dr Serdar Akgün, aneurysm. We inflated the balloon and deployed the Marmara Üniversitesi Hastanesi, Kalp Damar Cerrahisi ABD, Tophanelioglu Cad. 13–15, 81190 Altunizade, Istanbul, Turkey. stent graft. Arteriography revealed complete exclusion