Endovascular treatment of acute subclavian pseudo-aneurysm after fracture of the clavicle

Pseudo-aneurysms of the subclavian artery remain a rare complication after fracture of the clavicle. Nerve compression has been described with delayed paralysis as a consequence. We report a case of delayed diagnosis of a subclavian pseudo-aneurysm after a closed fracture of the clavicle in a 93-year-old patient. Diagnosis was confirmed by ultrasound and multi-slice-Ct. Two attempts to treat the pseudo-aneurysm with percutaneous thrombin injection failed. Considering the age of the patient, it was decided to exclude the pseudo-aneurysm by endovascular approach. A Hemobahn endoprosthesis was inserted by the introduction of an 11F sheath after cutting down the brachial artery under local anaesthesia. Angiography revealed complete exclusion of the pseudo-aneurysm. Follow-up at 9 months by ultrasound confirmed exclusion of the pseudo-aneurysm. Plain X-ray of the endograft showed no stent fractures. Paresis of the arm had improved. This case illustrates that endovascular exclusion is a safe approach, with reduced morbidity, compared with open surgery. Concern about stent deformation and stent fractures has been expressed. With the introduction of highly flexible stents, one can hope that this complication is less likely to occur. Although follow-up is relatively short, we believe that endovascular exclusion of subclavian pseudo-aneurysms is preferable to a surgical approach.