An unusual presentation of thoracoacromial artery pseudoaneurysm following shoulder arthroplasty

Abstract

Pseudoaneurysms of peripheral arteries are not an uncommon condition presenting to vascular surgeons. Perioperative injury and infection are two of the commonest causes. We describe a case of an 82-year-old lady, who presented 10 years following right shoulder joint replacement, with a sharply marginated erythematous cutaneous eruption over the right shoulder. Subsequent angiography revealed a pseudoaneurysm of the acromial branch of the thoracoacromial artery. Planned intervention was superseded by a further embolic episode, which prompted immediate percutaneous translumninal embolisation of the aneurysm. The aetiology of a pseudoaneurysm 10 years following shoulder arthroplasty is discussed.

Figure 1

Distribution of the cutaneous eruption.

Figure 2

Subtracted digital selective arteriogram of the right axillary artery. The aneurysm shows a biloculated appearance and is interposed between the clavicle and the humeral head prosthesis.

Figure 3

Subtracted postembolisation arteriogram in the late arterial phase of contrast enhancement. The majority of the acromial artery and the aneurysm sac are occluded.