Complex subclavian artery pseudoaneurysm causing failure of endovascular stent repair with salvage by percutaneous thrombin injection

Journal of Vascular Surgery
Grace S LeeRaymond Hung

Abstract

We report a case of traumatic right subclavian artery pseudoaneurysm, which failed initial treatment by endovascular covered stent. Subsequent catheter angiogram demonstrated filling of the pseudoaneurysm from retrograde flow of the right vertebral artery with outflow through the internal mammary artery. With access to the pseudoaneruysm obstructed, percutaneous thrombin injection was performed. The complex connections of the pseudoaneurysm to the right subclavian, vertebral, and internal mammary arteries resulted in the initial failure of the covered stent to induce thrombosis because of inflow from the right vertebral artery, a so-called "back door vessel".

References

Aug 1, 1986·AJR. American Journal of Roentgenology·C Cope, R Zeit
Jul 1, 1980·The Journal of Trauma·J M GrahamM E DeBakey
Sep 1, 1995·Journal of Vascular Surgery·R T ChalmersA W Bradbury
Feb 9, 2000·Journal of Vascular Surgery·S S KangW H Baker

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Citations

Aug 28, 2012·Injury·Joseph J DuBoseUNKNOWN Endovascular Skills for Trauma and Resuscitative Surgery Working Group
Jul 5, 2016·Annals of Vascular Diseases·Yoshiyuki YamashitaYasutaka Ueno
Aug 2, 2018·Journal of Medical Ultrasound·Jamal JeffersonDevang Butani

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