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

Rodríguez-Merchán, E. Carlos; Gómez-Cardero, Primitivo

doi:10.1007/s12306-010-0076-5

Cited by 11 publications

(5 citation statements)

References 3 publications

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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: 74%

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: 74%

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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“…Concerns over the deleterious effects of displaced medial clavicle fractures on other surrounding structures as well as the high nonunion rate (8–14%) and poor patient outcomes with nonoperative management have led some to favor surgical stabilization of these injuries [7,17,18,26]. Neurovascular complications that have been associated with medial clavicle fractures include pseudoaneurysm formation, subclavian arterial thrombosis and brachial plexus palsy [27–30]. In contrast to adults, our patients did not have any associated injuries and often sustained their fractures from direct impact during sporting incidents.…”

Section: Discussionmentioning

confidence: 97%

“…Neurovascular Fig. 3 The shape of the medial clavicle on CT scan shows the curve with anterior apex (*) complications that have been associated with medial clavicle fractures include pseudoaneurysm formation, subclavian arterial thrombosis and brachial plexus palsy [27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Medial clavicle shaft fractures in children and adolescents: differences from adults and management

Whyte

Veerkamp²,

Parikh³

2022

Journal of Pediatric Orthopaedics B

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Clavicle fractures are a common injury in the pediatric and adolescent population. Most fractures are located in the middle third of the clavicle. There has been no information in the literature regarding the management of extra-physeal medial clavicle shaft fractures in this population. The objective of this study is to evaluate demographic and injury characteristics, management options and clinical outcomes of medial clavicle fractures in children and adolescents and differentiate them from those in adults. A retrospective review was performed at a single institution to identify patients with medial clavicle shaft fractures. Radiographs, clinical features and patient-reported outcomes (QuickDASH) were analyzed. Eight patients were identified with medial clavicle fractures. Two fractures could not be diagnosed on anteroposterior radiographs. Both operative (four patients) and nonoperative (four patients) treatment had excellent radiographic and clinical outcomes, irrespective of initial displacement. Compared to high-energy and life-threatening injuries in adults, these fractures in children and adolescents were sports-related and isolated fractures. Conservative treatment should be considered for medial clavicle fractures in children and adolescents. These fractures are distinct from their adult counterparts and do not lead to increased morbidity or mortality.

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“…11 Early complications have been described with patients presenting within months of a clavicular fracture with a pulsatile mass and hand ischemia. 12,13 The development of late neurologic symptoms from subclavian artery pseudoaneurysm following clavicular fracture is a rare presentation as well. Both the studies by Watanabe and Matsumura, and Tachtsi et al describe open repair of a subclavian artery pseudoaneurysm causing nerve compression several years after the clavicle fracture.…”

Section: Discussionmentioning

confidence: 99%

Open Surgical Approach for Type II Endoleak in Subclavian Artery Pseudoaneurysm Presented With Neurological Symptoms After Endovascular Repair

Malekpour

Hebeler

Kirkwood

2020

Vasc Endovascular Surg

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We present a rare case of a 10-cm right subclavian artery pseudoaneurysm, with slow growth over 4 years after a traumatic fracture of the right clavicle. The patient had multiple prior endovascular attempts of embolization and stenting at other hospitals; despite this the pseudoaneurysm continued to grow and caused mass effect and neurologic symptoms. We present our open approach for the repair and a review of literature.

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

Cited by 11 publications

References 3 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

Medial clavicle shaft fractures in children and adolescents: differences from adults and management

Open Surgical Approach for Type II Endoleak in Subclavian Artery Pseudoaneurysm Presented With Neurological Symptoms After Endovascular Repair

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