Angio-Seal Closure for Traumatic Left Subclavian Artery Pseudoaneurysm: A Case Report

Abstract

Subclavian artery pseudoaneurysms are rare and associated with high morbidity and mortality. Alternative approaches to open surgical repair can include endovascular repair or ultrasound-guided thrombin injection. Here, we describe a safe and novel technique of closure of a subclavian artery pseudoaneurysm with Angio-Seal that was unresponsive to thrombin injection and in a difficult location for open repair.

Keywords: Angioseal; peripheral intervention; pseudoaneurysm; vascular closure device.

Figure 1

CT angiography (A) transaxial with corresponding (B) coronal and (C) sagittal views showing the left subclavian artery pseudoaneurysm and large supraclavicular hematoma with (D) 3D reconstruction. The white arrow points to the pseudoaneurysm neck.

Figure 2

Digital subtraction angiography of the left subclavian artery (SCA) pseudoaneurysm. A 5F Berenstein catheter and guide wire combination were advanced via the right femoral artery to access the left SCA pseudoaneurysm. Contrast injection in the anterior-posterior view confirmed the position of the catheter at the left SCA pseudoaneurysm.

Figure 3

Fluoroscopy in anterior-posterior view of ultrasound-guided puncture of the left subclavian pseudoaneurysm puncture from the left supraclavicular. Using ultrasound guidance, Angiocath puncture of the patent pseudoaneurysm via the left supraclavicular position with contrast injection confirming position within the pseudoaneurysm.

Figure 4

Digital subtraction angiography showing Angio-Seal advanced into the pseudoaneurysm from the left supraclavicular puncture. A 0.035” exchange length guide wire from the left supraclavicular access was then snared and pulled through the sheath, resulting in through-and-through access (not shown). A 6F Angio-Seal sheath was advanced over the guide wire under fluoroscopic guidance and deployed.

Figure 5

Digital subtraction angiography of the left subclavian artery following the deployment of the Angio-Seal. Angiography demonstrated occlusion of flow within the pseudoaneurysm with preserved antegrade flow in the left subclavian, axillary, vertebral arteries, and left internal mammary arteries.