J Korean Fract Soc.  2014 Jan;27(1):82-87. 10.12671/jkfs.2014.27.1.82.

Acute Rupture of Subclavian Artery Pseudoaneurysm after Delayed Osteosynthesis of Clavicular Fracture: A Case Report

• Shon OJ
• Kim JH
• Park KH

• KMID: 1817007
• DOI: http://doi.org/10.12671/jkfs.2014.27.1.82

Abstract

Subclavian vessels are well protected by muscles, fascia and sheaths, so vascular complications associated with clavicular fractures are rare. Pseudoaneurysms after clavicular fractures have been reported, and the occurrence or rupture of pseudoaneurysm has been reported rarely as a late complication. However, cases of pseudoaneurysm after rupture of the clavicular fracture following delayed osteosynthesis of the clavicular fracture have not been reported. A 58-year-old female that presented with a right clavicular shaft fracture obtained conservative treatment. Surgery was performed after 4 months because of non-union in the local medical center. After operation, rupture of the subclavian pseudoaneurysm occurred following osteosynthesis of the clavicular shaft fracture. We report this case here with a review of the literature.

Keyword

Clavicle; Fractures; Complication; Subclavian artery; Aneurysm; False

MeSH Terms

Aneurysm
Aneurysm, False*
Clavicle
Fascia
Female
Humans
Middle Aged
Muscles
Rupture*
Subclavian Artery*

Figure

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  Fig. 1 Initial radiograph showing clavicular mid-shaft fracture.

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  Fig. 2 Preoperative radiograph showing nonunion of the clavicle mid-shaft fracture at 4 months after injury.

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  Fig. 3 Preoperative T2 magnetic resonance imaging showing a suspicious lesion of the subclavian pseudoaneurysm (white arrows).

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  Fig. 4 Postoperative radiograph showing nonunion of the clavicle mid-shaft fracture treated using an anatomical plate.

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  Fig. 5 (A, B) Angio computed tomography showing subclavian pseudoaneurysm (white arrow) and arteriovenous fistula (black arrow). (C) Three-dimensional angio computed tomography showing subclavian pseudoaneurysm (white arrow).

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  Fig. 6 Intraoperative photograph showing the status of clavicular osteotomy. The subclavian artery pseudoaneurysmal sac was removed and an arterial opening (black arrow) was observed.

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  Fig. 7 Postoperative radiograph showing osteosynthesis of the clavicular osteotomy after vessel repair.

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  Fig. 8 Follow-up 3-dimensional computed tomography angiogram showing good distal blood flow to the axillary artery through a subclavian artery graft.

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  Fig. 9 Photographs showing recovery state of upper extremities, but with limitation of motion.

Reference

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