Subclavian artery pseudoaneurysms are rare and occur mostly as a consequence of an inadvertent arterial puncture during central venous catheterization, endovascular therapeutic procedures or after penetrating or blunt trauma. They usually have a late clinical presentation, with pain, swelling or other compressive symptoms. We present a 40-year old man farmer who presented to our service with prior 14 days and 12 days history of left chest upper chest swelling and inability to use the left upper limb respectively, all on account of injury. He went on a night alcohol binge, got drunk and while getting to his sitting room slipped and fell on a nearby glass center table. He had a deep cut on the left upper anterior chest wall. There was immediate profuse spurting bleeding with estimated blood loss of 800 ml. After delay in definitive treatment due to financial constraint the aneurysm increased in size, ruptured and rebled profusely leading to syncope. He was managed by Doppler ultrasound, median sternotomy and subclavian artery exploration to achieve proximal and distal vascular control. Sac was entered into via an infraclavicular transverse incision, heamatoma manually evacuated, bleeding site isolated and secured. He received 5 units of blood. Postoperative course was uneventful as he was managed with analgesics, antibiotics, haematinics and physiotherapy. Power in the upper limb has improved to 3 around the shoulder, 2 around the elbow and 1 around the wrist.
| Published in | International Journal of Cardiovascular and Thoracic Surgery (Volume 7, Issue 2) |
| DOI | 10.11648/j.ijcts.20210702.12 |
| Page(s) | 16-19 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2021. Published by Science Publishing Group |
Giant, Bleeding, Aneurysm, Left Subclavian Artery, Brachial Plexus
| [1] | Vvyas JM, Subramman RK, Kumar SKS, Branching Pattern of Subclavian Artery: Cadavericc Study. Journal of Clinical and Diagnostic Research 2018; 12 (12): AC11-AC12. |
| [2] | Yuca AH, Kizilkanat E, Ocdemir CO, Variations of the subclavian artery and its branches. Okajimas Folia Anatomica Japonica 1998; 76 (5): 255-262. |
| [3] | Ferreira RS, Castro JM, Concalves FB, Moreu R, Correla R, Rodriguez R et al. Surgical Management of Subclavian Artery Pseudoaneurysm: A case report and literature. Rev Port Cir Cardiovascular Surg 2017; 24 (3-4): 105-106. |
| [4] | Asai M, Van Houtte O, Sullivan TR, Garrido M, Pineda DM. Endovascular Repair of Three Concurrent Mycotic Pseudoaneurysm. Vasc Endovasc Surg 2016; 52 (6): 473-477. Doi: 1177/1538574418772458. |
| [5] | bDavidovic LB, Markovic DM, Pejkic SD, Kovacevic NS, Colic MM, Doric PM. Subclavian artery aneurysms. Asian J Surg. 2003; 26: 7–11 |
| [6] | Utikal P, Bachleda P, Kocher M, Novotny J, Drac P, Drac P. Aneurysm of the subclavian artery. Acta Univ Palacki Olomuc Fac Med. 1999; 142: 107–9. |
| [7] | Dougherty MJ, Calligaro KD, Savarese RP, DeLaurentis DA. Atherosclerotic aneurysm of the intrathoracic subclavian artery: A case report and review of the literature. J Vasc Surg. 1995; 21: 521–9. |
| [8] | Enamorado-Enamorado J, Guerrero JJ, Revuelto-Rej J, Gordillo-Escobar E, Herreira-Metero C. Left Subclavian Artery Pseudoaneurysm aftea Traffic Accident: A Case Report. Hindawi Publishing Corporation Case Reports in Critical Care Volume 2011, Article 451819, 2 pages\ doi: 10.1155/2011/451819. |
| [9] | Cires G, Noll RE, Jr, Albuquerque FC, Jr, Tonnessen BH, Sternbergh WC., 3rd Endovascular debranching of the aortic arch during thoracic endograft repair. J Vasc Surg. 2011; 53: 1485–91. |
| [10] | Hernandez JA, Pershad A, Laufer N. Subclavian artery pseudoaneurysm successful exclusion with a covered self-expanding stent. J Invasive Cardiol. 2002; 14: 278–9. |
| [11] | Nwafor IA, Eze JC, Ezemba N, Anyanwu CH. The challenges faving the management of arterial aneurysms in UNTH, Enugu, Nigeria. Nig J of Med 2013; 21 (4): 438-40. |
| [12] | Nwafor IA, Eze JC, Ezemba N, Ngene CI, Akpan AF, Giant pseudoaneurysm of a splanchnic artery; A Case Report. Nig J Med 2015; 24 (3): 268-272. |
| [13] | Eze JC, Ezemba N, Adamu Y. A study of Extracranial Artery Aneurysm at UNTH, Enugu. Nig J Clin Practice 2010; 13 (3): 272-5. |
APA Style
Nwafor Ikechukwu Andrew, Emeruem Nwadinma Uloma, Onyia Ugochukwu Obinna Chibuife, Eze John Chukwuemeka, Okorie Chukwuemeka Ogueri. (2021). Giant Bleeding Pseudo-aneurysm of left Sub-clavian Artery Complicating Neurologic Impairment: Management Challenges (Case Report). International Journal of Cardiovascular and Thoracic Surgery, 7(2), 16-19. https://doi.org/10.11648/j.ijcts.20210702.12
ACS Style
Nwafor Ikechukwu Andrew; Emeruem Nwadinma Uloma; Onyia Ugochukwu Obinna Chibuife; Eze John Chukwuemeka; Okorie Chukwuemeka Ogueri. Giant Bleeding Pseudo-aneurysm of left Sub-clavian Artery Complicating Neurologic Impairment: Management Challenges (Case Report). Int. J. Cardiovasc. Thorac. Surg. 2021, 7(2), 16-19. doi: 10.11648/j.ijcts.20210702.12
AMA Style
Nwafor Ikechukwu Andrew, Emeruem Nwadinma Uloma, Onyia Ugochukwu Obinna Chibuife, Eze John Chukwuemeka, Okorie Chukwuemeka Ogueri. Giant Bleeding Pseudo-aneurysm of left Sub-clavian Artery Complicating Neurologic Impairment: Management Challenges (Case Report). Int J Cardiovasc Thorac Surg. 2021;7(2):16-19. doi: 10.11648/j.ijcts.20210702.12
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Download@article{10.11648/j.ijcts.20210702.12,
author = {Nwafor Ikechukwu Andrew and Emeruem Nwadinma Uloma and Onyia Ugochukwu Obinna Chibuife and Eze John Chukwuemeka and Okorie Chukwuemeka Ogueri},
title = {Giant Bleeding Pseudo-aneurysm of left Sub-clavian Artery Complicating Neurologic Impairment: Management Challenges (Case Report)},
journal = {International Journal of Cardiovascular and Thoracic Surgery},
volume = {7},
number = {2},
pages = {16-19},
doi = {10.11648/j.ijcts.20210702.12},
url = {https://doi.org/10.11648/j.ijcts.20210702.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20210702.12},
abstract = {Subclavian artery pseudoaneurysms are rare and occur mostly as a consequence of an inadvertent arterial puncture during central venous catheterization, endovascular therapeutic procedures or after penetrating or blunt trauma. They usually have a late clinical presentation, with pain, swelling or other compressive symptoms. We present a 40-year old man farmer who presented to our service with prior 14 days and 12 days history of left chest upper chest swelling and inability to use the left upper limb respectively, all on account of injury. He went on a night alcohol binge, got drunk and while getting to his sitting room slipped and fell on a nearby glass center table. He had a deep cut on the left upper anterior chest wall. There was immediate profuse spurting bleeding with estimated blood loss of 800 ml. After delay in definitive treatment due to financial constraint the aneurysm increased in size, ruptured and rebled profusely leading to syncope. He was managed by Doppler ultrasound, median sternotomy and subclavian artery exploration to achieve proximal and distal vascular control. Sac was entered into via an infraclavicular transverse incision, heamatoma manually evacuated, bleeding site isolated and secured. He received 5 units of blood. Postoperative course was uneventful as he was managed with analgesics, antibiotics, haematinics and physiotherapy. Power in the upper limb has improved to 3 around the shoulder, 2 around the elbow and 1 around the wrist.},
year = {2021}
}
TY - JOUR T1 - Giant Bleeding Pseudo-aneurysm of left Sub-clavian Artery Complicating Neurologic Impairment: Management Challenges (Case Report) AU - Nwafor Ikechukwu Andrew AU - Emeruem Nwadinma Uloma AU - Onyia Ugochukwu Obinna Chibuife AU - Eze John Chukwuemeka AU - Okorie Chukwuemeka Ogueri Y1 - 2021/05/26 PY - 2021 N1 - https://doi.org/10.11648/j.ijcts.20210702.12 DO - 10.11648/j.ijcts.20210702.12 T2 - International Journal of Cardiovascular and Thoracic Surgery JF - International Journal of Cardiovascular and Thoracic Surgery JO - International Journal of Cardiovascular and Thoracic Surgery SP - 16 EP - 19 PB - Science Publishing Group SN - 2575-4882 UR - https://doi.org/10.11648/j.ijcts.20210702.12 AB - Subclavian artery pseudoaneurysms are rare and occur mostly as a consequence of an inadvertent arterial puncture during central venous catheterization, endovascular therapeutic procedures or after penetrating or blunt trauma. They usually have a late clinical presentation, with pain, swelling or other compressive symptoms. We present a 40-year old man farmer who presented to our service with prior 14 days and 12 days history of left chest upper chest swelling and inability to use the left upper limb respectively, all on account of injury. He went on a night alcohol binge, got drunk and while getting to his sitting room slipped and fell on a nearby glass center table. He had a deep cut on the left upper anterior chest wall. There was immediate profuse spurting bleeding with estimated blood loss of 800 ml. After delay in definitive treatment due to financial constraint the aneurysm increased in size, ruptured and rebled profusely leading to syncope. He was managed by Doppler ultrasound, median sternotomy and subclavian artery exploration to achieve proximal and distal vascular control. Sac was entered into via an infraclavicular transverse incision, heamatoma manually evacuated, bleeding site isolated and secured. He received 5 units of blood. Postoperative course was uneventful as he was managed with analgesics, antibiotics, haematinics and physiotherapy. Power in the upper limb has improved to 3 around the shoulder, 2 around the elbow and 1 around the wrist. VL - 7 IS - 2 ER -
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