Deep Brachial Artery Pseudoaneurysm Following Arthroscopic Shoulder Debridement

Abstract

Vascular injuries resulting from arthroscopic surgeries are rare with a reported incidence of 0.005% of elective orthopedic procedures. We report a case of a 49-year-old male who developed a deep brachial artery pseudoaneurysm following an arthroscopic shoulder debridement and lysis of adhesions. He was successfully embolized with resolution of the pseudoaneurysm within 6 weeks of treatment. A review of the literature demonstrates that pseudoaneurysm formation after arthroscopic procedures is rare and pseudoaneurysms of the deep brachial artery have yet to be reported.

Pseudoaneurysm of the posterior circumflex humeral artery after arthroscopic rotator cuff repair : a case report

“…17 Shoulder pseudoaneurysms are extremely rare. 24 They mainly develop after trauma 24,33 and rarely occur after shoulder surgery 4,13,36,38 or in overhead athletes. 29 There have only been 6 reported cases of pseudoaneurysms after arthroscopic shoulder surgery.…”

“…29 There have only been 6 reported cases of pseudoaneurysms after arthroscopic shoulder surgery. 3,4,13,17,36,38 The size of pseudoaneurysms increases over several days after the injury, making early detection difficult. 7,14,28 Symptoms and signs may include pain, tenderness, and a pulsatile mass.…”

“…The case reports on pseudoaneurysms after arthroscopic shoulder surgery have included only short-term followup. 4,13,36,38 ARCRs of high-grade partial-thickness tears and small-to medium-sized full-thickness tears have shown good functional outcomes according to the ASES score. 22,26 In our case, at 1 year postoperatively, the patient showed rotator cuff healing on MRI and had almost full ROM, although she showed poor functional outcomes in terms of the VAS and ASES scores (5 and 63, respectively).…”

“…In these cases, the pseudoaneurysm was identified in branches of the thoracoacromial artery, deep brachial artery, and cephalic vein. 3,4,13,17,36,38 Because this is an extremely rare complication, the diagnosis and interventions are often missed or delayed. Some cases have required amputation owing to pseudoaneurysm rupture and embolism.…”

Vascular Complications in Sports Surgery: Diagnosis and Management

“…Yang et al 78 describes a case of a deep brachial artery pseudoaneurysm that presented with swelling for 9 months following an arthroscopic lysis of adhesions for adhesive capsulitis. A joint aspiration revealed a large amount of blood under pressure and further evaluation with a CT angiogram found an arterial component to the collection of fluid.…”