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Case Reports
. 2018 Jul;97(29):e11262.
doi: 10.1097/MD.0000000000011262.

Mini-invasive Treatment of a Large Pseudoaneurysm of the Neck Related to Central Venous Catheter Placement: A Case Report

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Free PMC article
Case Reports

Mini-invasive Treatment of a Large Pseudoaneurysm of the Neck Related to Central Venous Catheter Placement: A Case Report

Chiara Palermo et al. Medicine (Baltimore). .
Free PMC article

Abstract

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.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cervical computed tomography angiography in axial (A) and sagittal (B) view, showing a large false aneurysm of the neck, with a likely origin from the thyrocervical trunk, with no signs of peri-arterial bleeding or hematoma.
Figure 2
Figure 2
Selective Angiography of the right thyro-cervical trunk confirmed the presence of the pseudoaneurysm (A, arrow) with active communication with the artery (B, arrow).
Figure 3
Figure 3
Endovascular repair of the pseudoaneurysm. A balloon expandable covered stent was released in the thyro-cervical trunk (A, arrow), and the post-procedure angiography confirmed the complete exclusion of the pseudoaneurysm and the patency of the inferior thyroid artery (B).
Figure 4
Figure 4
Mechanism of arterial injury. During the central venous catheter placement the needle was pushed too deep in the neck causing an accidental puncture of the thyro-cervical trunk (A, arrow). The unrecognized arterial injury in a patient with anticoagulation therapy slowly progressed to the formation of a giant pseudoaneurysm (B).

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