Korean J Crit Care Med.  2015 Aug;30(3):222-226. 10.4266/kjccm.2015.30.3.222.

Delayed Presentation of Catheter-Related Subclavian Artery Pseudoaneurysm

• Kang HR
• Park JY
• Kim JH
• Kim Y
• Kang MH
• Chang Y
• Choe KH
• Lee KM
• An JY

• KMID: 2227654
• DOI: http://doi.org/10.4266/kjccm.2015.30.3.222

Abstract

Central venous catheterization is a common diagnostic and therapeutic procedure in modern clinical practice. Pseudoaneurysms of the subclavian artery are rare and usually occur immediately after the causative event, whether the cause was trauma or a medical procedure. Here we report the rare case of a 71-year-old woman with delayed presentation of catheter-related subclavian pseudoaneurysm. The patient was treated for aspiration pneumonia with respiratory failure in another hospital. The patient's chest wall swelling began two weeks after the initial catheterization in the other hospital, probably because of slow leakage of blood from the injured subclavian artery caused by incomplete compression of the puncture site and uremic coagulopathy. She was successfully treated with ultrasound-guided thrombin and angiography-guided histoacryl injection without stent insertion or surgery. Her condition improved, and she was discharged to her home.

Keyword

aneurysm, false; enbucrilate; subclavian artery; thrombin

MeSH Terms

Aged
Aneurysm, False*
Catheterization
Catheterization, Central Venous
Catheters
Central Venous Catheters
Enbucrilate
Female
Humans
Pneumonia, Aspiration
Punctures
Respiratory Insufficiency
Stents
Subclavian Artery*
Thoracic Wall
Thrombin
Enbucrilate
Thrombin

Figure

• 

  Fig. 1. Chest computed tomography (CT) scanning. It revealed a 2.6-cm enhancing nodular lesion, suggesting a pseudoaneurysm at the left subclavicular area with surrounding hematoma (arrow) (A). CT scanning after embolization revealed no bleeding and a smaller hematoma (B).

• 

  Fig. 2. An ultrasound-guided thrombin injection was performed at the pseudoaneurysm of the left subclavian artery (A: pre-injection, B: post-injection).

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  Fig. 3. Angiography findings. It revealed active bleeding of a branch of the left subclavian artery (arrow) (A). After embolization, angiography showed no evidence of extravasations of contrast media (arrow) (B).

Reference

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