Delayed brachial plexus paralysis due to subclavian pseudoaneurysm after clavicular fracture

Hansky, Bert; Murray, Eric; Minami, Kazunori; Körfer, Reiner

doi:10.1016/1010-7940(93)90281-f

Cited by 55 publications

(29 citation statements)

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“…1) Several case reports have described pseudoaneurysm formation that was associated with nonunion or delayed union of the clavicle. 1,7,8) However, our case is unique, as the clavicle nonunion had been asymptomatic for 30 years before the vascular complication, and this type of case has never been reported.…”

Section: Discussionmentioning

confidence: 76%

Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

Nagato

Touma

Ohno

et al. 2015

Annals of Vascular Diseases

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We report the case of a 62-year-old man who experienced a left axillary artery pseudoaneurysm that was secondary to nonunion of a 30-year-old left midshaft clavicle fracture. He initially underwent endovascular repair using a self-expanding nitinol stent graft, which was perforated at postoperative day 5. Therefore, we performed open repair with concomitant clavicle resection, and no complications were observed during an approximately 6-year follow-up. We recommend performing clavicle resection with vascular repair to prevent recurrence in similar cases.Keywords: axillary artery pseudoaneurysm, clavicle nonunion, early stent graft perforation clavicle. Computed tomography (CT) revealed nonunion of a 30-year-old left midshaft clavicle fracture after improper fixation using a wire (Fig. 1A). The patient also reported experiencing paresthesia around his left shoulder at approximately 1 month before his admission. Enhanced CT revealed a pseudoaneurysm that originated from the first segment of the left axillary artery at the first rib (Fig. 1B). Based on these findings, the patient underwent EVT using a self-expanding Fluency Plus stent graft (10 mm × 40 mm). He reported that the pain resolved immediately and the abnormal pulsation disappeared. Therefore, he was discharged at postoperative day 5, and was cautioned to avoid abduction movement (>90°) of his left upper limb.However, the same pain and abnormal pulsation returned on the night after his discharge. He was re-admitted to our hospital and underwent CT and angiography, which revealed a recurrent pseudoaneurysm due to stent graft perforation ( Fig. 2A-2C). Both the covering graft material and the stent structure were compromised, and the stent was dilated and perforated at the midpoint (type III endoleak), although no type I or type II endoleaks were observed. Therefore, two balloon catheters were placed proximal and distal to the perforation, and were inflated to control the pressure in the pseudoaneurysm.The patient was then transferred to the operating theater for resection of the pseudoaneurysm. A diagonal skin incision was made across his clavicle (from the upper proximal side to the lower distal side), and we resected a part of the clavicle that was proximal to the nonunion. We also attempted to dissect the proximal and distal axillary arteries outside the pseudoaneurysm. However, severe adhesion made the dissection difficult, and although we secured the distal axillary artery, we could not secure the proximal axillary artery. There was a risk of brachial plexus injury if we performed further dissection, and we elected to open the pseudoaneurysm. We controlled the bleeding from the perforation digitally, placed a proximal vascular clamp (as well as a distal clamp after dissecting the vessel), and removed the stent graft. Next, we replaced the injured vessel with a 10-mm woven double velour tube

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Section: Discussionmentioning

confidence: 76%

Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

Nagato

Touma

Ohno

et al. 2015

Annals of Vascular Diseases

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“…In our review, early surgical intervention of compressive hematoma within 48 h resulted in improvement in all patients while late intervention after 48 h resulted in improvement in about half of patients. [78910] Our patient had progressive signs and symptoms of brachial plexopathy.…”

Section: Discussionmentioning

confidence: 85%

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

2017

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Internal jugular vein (IJV) catheterization has become the preferred approach for temporary vascular access for hemodialysis. However, complications such as internal carotid artery puncture, vessel erosion, thrombosis, and infection may occur. We report a case of brachial plexus palsy due to compression by right subclavian artery pseudoaneurysm as a result of IJV catheterization in a patient who was under maintenance hemodialysis.

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“…Due to their close relationship to the brachial plexus, lesions of the latter are possible [2,3]. Clavicular fractures are occasionally responsible for lesions of the brachial plexus.…”

Section: Discussionmentioning

confidence: 99%

Delayed union of a fracture of the middle third of the clavicle presenting with a late subclavian pseudoaneurysm

Rodríguez-Merchán

Gómez-Cardero

2010

Musculoskelet Surg

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This is the case of a 46-year-old man who presented 3 months following a fracture of the middle third of the clavicle with an expanding mass in the supraclavicular fossa. Upon admission, a pulsatile mass was identified and X-rays showed delayed union of the fracture. Seven days after admission, skin necrosis developed. Arteriography performed 3 days later demonstrated a round subclavian pseudoaneurysm measuring 5 cm in diameter. It was occluded by means of an endovascular prosthesis. Four days after arteriography, the delayed union was treated by excision of the necrotic skin and internal fixation with a plate and screws. After 1 year of follow-up, the outcome was clinically and radiologically satisfactory.

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Delayed brachial plexus paralysis due to subclavian pseudoaneurysm after clavicular fracture

Cited by 55 publications

References 0 publications

Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

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

Delayed union of a fracture of the middle third of the clavicle presenting with a late subclavian pseudoaneurysm

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