Brachial plexus compression due to subclavian artery pseudoaneurysm from internal jugular vein catheterization

Mol, TN; Gupta, Arvind; Narain, Upma

doi:10.4103/0971-4065.179334

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…The most common mechanism is disruption of arterial continuity with extravasation of blood into surrounding tissue. This results in the formation of fibrous tissue capsule which progressively enlarges because of underlying arterial pressure [11].…”

Section: Discussionmentioning

confidence: 99%

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Brachial plexopathy due to subclavian artery pseudoaneurysm secondary to comminuted clavicle shaft fracture: A case report

Mabrouk¹

2022

J Clin Images Med Case Rep

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In adults, brachial plexopathy due to clavicle fractures is rare and is most commonly caused by nonunion, mal-united fragments, hypertrophic callus, or pseudoaneurysm of the subclavian artery or vein. Conservative treatment of nondisplaced and displaced clavicle shaft fractures in adults usually produces satisfactory outcomes. This article presents a case of a 82-year-old man who sustained a closed, comminuted midshaft left clavicle fracture complicated by brachial plexus injury secondary to pseudoaneurysm of the left subclavian artery. Initially, the fracture was treated conservatively. However, he returned 5 days later with left brachial plexopathy. Computed tomography angiogram confirmed left subclavian artery pseudoaneurysm secondary to the fracture. The patient had endovascular stenting of the left subclavian artery to exclude the aneurysm. 12 weeks later, he had malunited clavicle and no improvement in brachial plexus function. 16 weeks after the injury, he had left brachial plexus exploration, decompression and open reduction and internal fixation of his left clavicle mal-united fracture. 4 weeks post operative, patient started to develop signs suggestive of significant re-innervation.

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Section: Discussionmentioning

confidence: 99%

“…Duplex USG will help to differentiate between two, and a selective angiogram is necessary to determine precise origin and extent of injury. Because of close anatomic relationship between brachial plexus and subclavian artery in the thoracic inlet, even a small false aneurysm can result in compression injury to the neuroplexus [11].…”

Section: Discussionmentioning

confidence: 99%

Brachial plexopathy due to subclavian artery pseudoaneurysm secondary to comminuted clavicle shaft fracture: A case report

Mabrouk¹

2022

J Clin Images Med Case Rep

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“…There are few case reports in the literature describing the subclavian aneurysm causing brachial plexus injury even after removal of the subclavian central line with a partial recovery [ 3 ]. Also, subclavian artery pseudoaneurysm has been reported to cause brachial plexus injury [ 17 , 18 ]. The authors stated that early surgical intervention of compressive hematoma within the first 2 days showed improvement in all patients; however, late intervention > 2 days could lead to improvement in only 50% of cases [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Also, subclavian artery pseudoaneurysm has been reported to cause brachial plexus injury [ 17 , 18 ]. The authors stated that early surgical intervention of compressive hematoma within the first 2 days showed improvement in all patients; however, late intervention > 2 days could lead to improvement in only 50% of cases [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Balloon-Assisted Percutaneous Thrombin Injection for Treatment of Iatrogenic Left Subclavian Artery Pseudoaneurysm in a Critically Ill COVID-19 Patient

Al-Thani

Hussein

Sadek

et al. 2021

Case Reports in Vascular Medicine

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Background. Central venous catheter represents an important tool in the management of critically ill patient. In this report, we described a COVID-19-positive case who had COVID-related complications and iatrogenic left subclavian artery pseudoaneurysm after central venous catheter insertion. Case Presentation. A 58-year-old male patient presented with a high-grade fever, myalgia, and shortness of breath due to COVID-19 infection. He required mechanical ventilation support and hemodialysis. He also developed uneventful deep vein thrombosis and myocardial infarction. As a complication of central line insertion, the patient developed pseudoaneurysm that originated from the subclavian artery with significant bleeding and large hematoma. Balloon-assisted percutaneous thrombin injection was done under ultrasound guidance. The patient was extubated 2 days later with no evidence of flow in the pseudoaneurysm. However, he lost movement in the left arm secondary to the compression of the brachial plexus from the pseudoaneurysm/hematoma, and therefore, 1.5 litres of the hematoma was evacuated in the operating room through a lateral left chest wall incision along the anterior axillary line to relieve the compression over the brachial plexus. The patient declined surgical reconstruction of the brachial plexus, and the flaccid paralysis of the arm did not recover during the follow-up. Conclusion. This is a case of unusual complications of COVID infection and iatrogenic left subclavian artery pseudoaneurysm postcentral vein cannulation. Balloon-assisted percutaneous thrombin injection for treatment of left subclavian artery pseudoaneurysm is feasible; however, delayed diagnosis could be associated with long-term or permanent disability.

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Avoiding peripheral nerve injury in arterial interventions

Kuo

Park

Chow

et al. 2019

Diagn Interv Radiol

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Brachial plexus compression due to subclavian artery pseudoaneurysm from internal jugular vein catheterization

Cited by 3 publications

References 10 publications

Brachial plexopathy due to subclavian artery pseudoaneurysm secondary to comminuted clavicle shaft fracture: A case report

Brachial plexopathy due to subclavian artery pseudoaneurysm secondary to comminuted clavicle shaft fracture: A case report

Balloon-Assisted Percutaneous Thrombin Injection for Treatment of Iatrogenic Left Subclavian Artery Pseudoaneurysm in a Critically Ill COVID-19 Patient

Avoiding peripheral nerve injury in arterial interventions

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