Mini-invasive treatment of a large pseudoaneurysm of the neck related to central venous catheter placement: A case report.
Palermo, Chiara MD; Sanfiorenzo, Angelo MD; Giaquinta, Alessia Testo MD, PhD; Virgilo, Carla MD, PhD; Veroux, Massimiliano MD, PhD *; Veroux, Pierfrancesco MD
97(29):e11262, July 2018.
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Rationale: Central venous catheter (CVC) placement, particularly in emergency setting, may be associated with significant morbidity and mortality.
Patient concerns: A 33-year old woman with suspected pulmonary embolism, developed a pseudoaneurysm of the neck three days after a CVC placement in the right internal jugular vein, determining compression to adjacent neck structures.
Diagnoses: Computed tomography angiography and selective angiography demonstrated the presence of the pseudoaneurysm originating from the thyro-cervical trunk.
Interventions: The treatment was minimally invasive with endovascular exclusion first, and an open thrombectomy to resolve compressive syndrome two days later.
Outcomes: The color Doppler ultrasound confirmed the complete exclusion of the pseudoaneurysm with patency of the thyroid artery. A comprehensive review of literature on the risk factors and management of the unintended artery puncture was included.
Lessons: A correct technique under ultrasound guidance may reduce the incidence of unintended arterial injury during CVC placement. In patients with suitable anatomy and unfit for open repair, a minimally invasive approach provides a safe alternative to open surgery with excellent results.
Copyright (C) 2018 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.