scholarly journals Subclavian Artery Pseudoaneurysm Formation 3 Months after a Game of Rugby Union

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
T. Evans ◽  
S. Roy ◽  
M. Rocker
Keyword(s):  
Subclavian Artery ◽  
Rare Complication ◽  
Delayed Diagnosis ◽  
Duplex Ultrasound ◽  
Final Diagnosis ◽  
Rugby Union ◽  
Limb Ischaemia ◽  
Artery Pseudoaneurysm ◽  
Pseudoaneurysm Formation ◽  
Acute Limb Ischaemia

Pseudoaneurysms of the subclavian artery remain a rare complication after fracture of the clavicle. We report a case of delayed diagnosis of a subclavian artery pseudoaneurysm after a closed fracture of the clavicle in a 15-year-old patient, 3 months after the original injury while playing rugby union. Despite several attendances to the Emergency Department with vague symptoms, the final diagnosis was confirmed by duplex ultrasound and Computed Tomography of the thorax. Surgical repair was indicated due to acute limb ischaemia from distal embolisation from a large pseudoaneurysm, with the patient making a full recovery. This case highlights the need for clinical vigilance when assessing patients, particularly on repeated occasions when their recovery appears to be impaired. A thorough history and clinical examination can raise suspicion of even rare occurrences and aid prompt management.

Undiagnosed bilateral complete cervical rib with subclavian artery aneurysm presenting as acute ischaemic limb following high-altitude expedition

2021 ◽  
Vol 14 (2) ◽  
pp. e241194
Author(s):  
Raja Lahiri ◽  
Udit Chauhan ◽  
Ajay Kumar ◽  
Nisanth Puliyath
Keyword(s):  
High Altitude ◽  
Subclavian Artery ◽  
Thoracic Outlet Syndrome ◽  
Artery Aneurysm ◽  
Limb Ischaemia ◽  
Cervical Rib ◽  
Subclavian Artery Aneurysm ◽  
Acute Limb Ischaemia ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs

Arterial thoracic outlet syndrome is relatively rare and often exclusively seen in the presence of bony anomalies. High-altitude (HA) travel is commonly associated with thrombosis; however, arterial thromboembolism is less frequently described. We describe a case of a young man with undiagnosed bilateral cervical rib, who went for an HA trek, subsequent to which developed acute limb ischaemia of right arm. Diagnostic workup revealed a subclavian artery aneurysm as well along with complete bony bilateral cervical ribs. Thoracic outlet syndrome should be kept as a differential diagnosis in a case of acute limb ischaemia in a healthy adult.

The impact of a focused vascular lower limb arterial duplex (F-VLAD) scan in management decisions for acute limb ischaemia

Perfusion ◽  
2016 ◽  
Vol 32 (1) ◽  
pp. 74-80
Author(s):  
Pasha Normahani ◽  
Mohammed Aslam ◽  
Nigel J Standfield ◽  
Usman Jaffer
Keyword(s):  
Decision Making ◽  
Diagnostic Accuracy ◽  
Lower Limb ◽  
Predictive Value ◽  
Duplex Ultrasound ◽  
Full Duplex ◽  
Limb Ischaemia ◽  
Acute Limb Ischaemia ◽  
Significant Difference ◽  
The Impact

Objective: To establish the diagnostic accuracy of a ‘focused vascular lower limb arterial duplex scan (F-VLAD)’ developed to facilitate rapid decision-making for acute limb ischaemia (ALI). Methods: Ten cases of ALI were identified from our patient database; clinical details, history and examination findings were extracted from the clinical notes. Original ‘full’ duplex ultrasound (DUS) pictorial reports were ‘re-formatted’ to include only anatomical segments included in the ‘F-VLAD’ scan. The series of 10 reports were emailed to 1741 vascular surgeons. Each recipient received a random mixture of full and F-VLAD scans. Participants were asked regarding next step in management and confidence in decision-making (Likert scale; 1 strongly disagree, 5 strongly agree). The cases were again sent out to the same database and respondents were asked as to the cause of ischaemia (embolic or thrombosis). Results: Eighty-one participants responded to the first survey and 43 participants to the second survey. Participants felt more confident making decisions regarding management using the full duplex report compared to the F-VLAD report (4 (3-4) vs 3 (2-4), median (IQR); p<0.001). However, there was no significant difference in diagnostic accuracy (differentiating embolus from thrombosis) when comparing the F-VLAD and full DUS reports (85.4% vs 88.3%; p=0.461). F-VLAD and ‘full’ DUS reports had comparable sensitivity (85.1% vs 86.8%), specificity (85.6% vs 89.2%),positive predictive value (PPV) (80.4% vs 81.9%) and negative predictive value (NPV) (89.2% vs 92.2%), respectively. Conclusion: The F-VLAD scan has comparable accuracy to a traditional full DUS in diagnosing the underlying aetiology of ALI. This may facilitate surgeon-performed point-of-care DUS.

Claudication, Tibial Neuropathy, and Peripheral Lymphedema after Total Knee Arthroplasty

2016 ◽  
Vol 40 (4) ◽  
pp. 182-184
Author(s):  
J. G. Roberts
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Popliteal Artery ◽  
Vascular Complications ◽  
Duplex Ultrasound ◽  
Orthopedic Procedures ◽  
Permanent Disability ◽  
Artery Pseudoaneurysm ◽  
Pseudoaneurysm Formation ◽  
Total Knee

Vascular complications associated with orthopedic procedures, though rare, pose the potential for permanent disability or limb loss. Thermal, mechanical, and vibratory forces incurred during total knee arthroplasty may traumatize the popliteal artery leading to thrombosis, laceration, dissection, arteriovenous fistula, or pseudoaneurysm formation. Color duplex ultrasound (8 MHz), followed by digital subtraction angiography promptly diagnosed a large left popliteal artery pseudoaneurysm. Definitive surgical intervention via a posterior approach permitted direct arterial repair, venous decompression, and tibial neurolysis. There were no neurovascular sequelae. Adherence to both preoperative vascular assessment and meticulous surgical technique are crucial to mitigate against this potentially catastrophic injury.

Pseudoaneurysm of the left internal carotid artery following tonsillectomy

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 491-494 ◽  
Author(s):  
Vávrová ◽  
Slezácek ◽  
Vávra ◽  
Karlová ◽  
Procházka
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Rare Complication ◽  
Left Internal Carotid Artery ◽  
Acute Tonsillitis ◽  
Artery Pseudoaneurysm ◽  
Complete Occlusion ◽  
Endovascular Approach ◽  
Deep Neck Infections

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.

Stent-Graft Repair of a Mycotic Left Subclavian Artery Pseudoaneurysm

2003 ◽  
Vol 10 (1) ◽  
pp. 66-70 ◽  
Author(s):  
Junichiro Sanada ◽  
Osamu Matsui ◽  
Noboru Terayama ◽  
Satoshi Kobayashi ◽  
Tetsuya Minami ◽  
...  
Keyword(s):  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Artery Pseudoaneurysm ◽  
Stent Graft Repair

Acute Limb Ischaemia Following Elective Left Upper Lobectomy for Early NSCLC: A Rare but Serious Complication Arising from the Pulmonary Vein Stump

2020 ◽  
pp. 1-2
Author(s):  
James Elliott ◽  
Anand Iyer ◽  
James Elliott
Keyword(s):  
Pulmonary Vein ◽  
Ct Angiography ◽  
Mediastinal Lymph Node ◽  
Case Reports ◽  
Common Femoral Artery ◽  
Sudden Onset ◽  
Leg Pain ◽  
Limb Ischaemia ◽  
Left Upper Lobectomy ◽  
Acute Limb Ischaemia

Patients undergoing Left Upper Lobectomy (LUL) appear to be at risk of a unique post-operative complication that is not well-documented: Pulmonary Vein (PV) stump thrombosis +/- systemic arterial embolisation [1-3]. We describe the details of a rare case from our institution, present a review of this subject from the limited literature available, and suggest potential strategies to anticipate, detect and manage this entity. A 70 year old female patient underwent left upper lobectomy and mediastinal lymph node sampling via repeat left thoracotomy. The procedure was unremarkable apart from some adhesions. She progressed well post-operatively on the ward. On post-operative day 2 the patient developed sudden-onset left leg pain and paraesthesia and CT-Angiography confirmed the diagnosis of left common femoral artery embolus and left superior PV stump thrombosis. The patient returned to theatre for femoral embolectomy, continued systemic anticoagulation, and made an excellent recovery thereafter. The aetiology of this complication has been documented in some case reports, but it is not explored further in trials or thoracic surgery texts [2-3]. One cohort study involving CT-angiography after lobectomy surgeries found that left upper lobectomy was unique as a risk factor for PV stump thrombosis1. It may be related to the relatively longer LSPV stump and stasis of blood in the stump [4].

scholarly journals A case report of multisite arterial thrombosis in a patient with coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Marco Angelillis ◽  
Marco De Carlo ◽  
Andrea Christou ◽  
Michele Marconi ◽  
Davide M Mocellin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Arterial Thrombosis ◽  
Leg Pain ◽  
Nasopharyngeal Swab ◽  
Limb Ischaemia ◽  
Total Occlusion ◽  
Left Common Iliac Artery ◽  
Acute Limb Ischaemia ◽  
The Right

Abstract Background A systemic coagulation dysfunction has been associated with COVID-19. In this case report, we describe a COVID-19-positive patient with multisite arterial thrombosis, presenting with acute limb ischaemia and concomitant ST-elevation myocardial infarction and oligo-symptomatic lung disease. Case summary An 83-year-old lady with history of hypertension and chronic kidney disease presented to the Emergency Department with acute-onset left leg pain, pulselessness, and partial loss of motor function. Acute limb ischaemia was diagnosed. At the same time, a routine ECG showed ST-segment elevation, diagnostic for inferior myocardial infarction. On admission, a nasopharyngeal swab was performed to assess the presence of SARS-CoV-2, as per hospital protocol during the current COVID-19 pandemic. A total-body CT angiography was performed to investigate the cause of acute limb ischaemia and to rule out aortic dissection; the examination showed a total occlusion of the left common iliac artery and a non-obstructive thrombosis of a subsegmental pulmonary artery branch in the right basal lobe. Lung CT scan confirmed a typical pattern of interstitial COVID-19 pneumonia. Coronary angiography showed a thrombotic occlusion of the proximal segment of the right coronary artery. Percutaneous coronary intervention was performed, with manual thrombectomy, followed by deployment of two stents. The patient was subsequently transferred to the operating room, where a Fogarty thrombectomy was performed. The patient was then admitted to the COVID area of our hospital. Seven hours later, the swab returned positive for COVID-19. Discussion COVID-19 can have an atypical presentation with thrombosis at multiple sites.

scholarly journals Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kurniawan Kurniawan ◽  
I Dewa Nyoman Wibawa ◽  
Gde Somayana ◽  
I Ketut Mariadi ◽  
I Made Mulyawan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gastrointestinal Bleeding ◽  
Abdominal Trauma ◽  
Upper Gastrointestinal Bleeding ◽  
Rare Complication ◽  
Gastroduodenal Artery ◽  
Time Interval ◽  
Artery Pseudoaneurysm ◽  
History Of ◽  
Upper Gastrointestinal

Abstract Background Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. Case presentation A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding. Conclusion Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

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