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• W2056560418 abstract "We read with interest the article by Marin et al. (J VASC SURG 1994;20:466-73), which described their experience with the use of a combined stent/arterial graft device in the management of arterial trauma. We agree with the authors that, in certain circumstances, including trauma to the great vessels near their origin associated with other life-threatening injuries, this therapeutic option avoids major, technically demanding surgery. However, as a result of a recent experience in our unit in the treatment of a patient with an iatrogenic false aneurysm of the right subclavian and carotid arteries, we want to highlight a possible limitation of the use of endovascular stent/graft devices in this clinical setting. A 52-year-old woman was admitted under the care of the renal physicians in our institution with acute-on-chronic kidney failure. An attempt was made to place an intravenous catheter via the right jugular vein to commence venovenous hemofiltration. The physician performing this procedure experienced some difficulty in locating the internal jugular vein, and in fact the procedure was abandoned. In particular, it was stated that during this attempted central venous line placement, on two separate occasions, inadvertent arterial puncture had occurred, but it was believed that firm pressure had controlled this. Even so, the patient had development of severe bruising of the right side of the neck over the ensuing days. This appeared to be settling, and venovenous hemofiltration was performed via a temporary femoral venous line. Two weeks after the attempted neck line placement the patient had sudden acute pain in the right side of the neck associated with a dramatic increase in neck swelling. Clinically, this swelling was pulsatile and enlarging, although it did not cause tracheal deviation or respiratory compromise, and the patient was referred to our service for an opinion. A clinical diagnosis of a false aneurysm was made, and a duplex scan was ordered. This confirmed the presence of the lesion and suggested that the lesion was being fed from a defect in the proximal right subclavian artery. We elected to perform arch aortography, with a view to possibly placing a covered stent device as a means of treating this false aneurysm. The angiogram showed the false aneurysm clearly located adjacent to the right subclavian artery lateral to the origin of the vertebral artery. However, the films appeared to show the superior aspect of the false aneurysm being filled before the remainder of the lesion ( Fig. 1 ), raising the suspicion that there was more than one route by which blood could enter the false aneurysm cavity. Therefore we proceeded to operative exploration. After resecting the medial half of the right clavicle and gaining control of the right subclavian, innominate, and right common carotid arteries, a laceration of the thyrocervical trunk was identified, and this vessel was ligated. However, the false aneurysm continued to fill after restoring flow to the subclavian artery, and so further exploration from within the false aneurysm itself was undertaken. This revealed a second defect in the proximal right common carotid artery, which was oversewn and complete control was achieved. The patient had an unremarkable recovery from the procedure. This case presentation raises a number of interesting points pertinent to false aneurysms of the subclavian arteries in general and the decision process about their treatment in particular. It is clear from our experience that duplex scanning and angiography can be complementary investigations, particularly in the context of an iatrogenic needle injury to the artery in question. Indeed, in the case presented here, the angiogram raised the suspicion that more than one arterial injury had been sustained. This finding, taken together with the description of events at the time of the original injury, not only influenced our decision on the mode of treatment but also helped guide our operative approach to the false aneurysm. Wherever possible, we agree that the ideal treatment of iatrogenic false aneurysms should be by duplex scanning directed manual compression. However, it is clear that in certain circumstances, it is not possible to adopt such an approach because of the anatomic location of the injured vessel. The decision on the ideal management of such a lesion then lies between direct operative repair and the innovative covered stent approach described by Marin et al. Given our experience with an iatrogenic false aneurysm that had more than one associated arterial injury, we wondered whether the authors have had any experience with a similar lesion and if so, whether they have attempted its repair by an endovascular approach?" @default.
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• W2056560418 modified "2023-10-15" @default.
• W2056560418 title "The use of endovascular stented grafts in the management of traumatic false aneurysms: A caveat" @default.
• W2056560418 doi "https://doi.org/10.1016/s0741-5214(95)70150-8" @default.
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