Singh Inderpal, Swisher Jordan, Schreiber Theodore
Internal Medicine, Ascension St. John Hospital, Detroit, USA.
Cardiology, Ascension St. John Hospital, Detroit, USA.
Cureus. 2023 Jun 7;15(6):e40082. doi: 10.7759/cureus.40082. eCollection 2023 Jun.
Subclavian artery pseudoaneurysm (PSA) is a rare complication arising from transaxillary Impella device placement during high-risk percutaneous coronary intervention (PCI). Despite the increasing prevalence of Impella use, literature addressing this complication is scarce. This case emphasizes the limited existing evidence on subclavian artery PSA and highlights the importance of recognizing it as a potential risk. With high-risk PCI and Impella use gaining popularity, understanding this complication is crucial for early detection and appropriate management. A 62-year-old male with a past medical history of type II diabetes mellitus, peripheral artery disease, hypertension, and chronic tobacco use presents with recurrent episodes of exertional chest pain and dyspnea. Initial workup with an electrocardiogram showed ST-segment elevations in the anteroseptal leads. The patient underwent right- and left-sided cardiac catheterization, which revealed severe stenosis of the left anterior descending artery and findings of cardiogenic shock. The patient required mechanical circulatory support with a percutaneous left ventricular assist device during the procedure; this was placed via transaxillary approach due to the patient having peripheral artery disease in bilateral femoral arteries. The patient had a complicated clinical course, but the patient's clinical picture slowly improved, and the percutaneous left ventricular assist device was removed. Roughly six weeks after the removal of the device, the patient developed a large fluid collection in the chest wall anterior to the left shoulder. Imaging revealed a ruptured left distal subclavian artery PSA. The patient was promptly taken to the catheterization laboratory and a covered stent was deployed over the site of the PSA. Repeat angiography revealed brisk flow through the left subclavian artery into the axillary artery with no extravasation into the chest wall.
锁骨下动脉假性动脉瘤（PSA）是高危经皮冠状动脉介入治疗（PCI）期间经腋动脉置入Impella装置引起的一种罕见并发症。尽管Impella的使用越来越普遍，但针对这一并发症的文献却很匮乏。本病例强调了关于锁骨下动脉PSA的现有证据有限，并突出了将其识别为潜在风险的重要性。随着高危PCI和Impella的使用日益普及，了解这一并发症对于早期发现和恰当处理至关重要。一名62岁男性，有II型糖尿病、外周动脉疾病、高血压病史且长期吸烟，因劳力性胸痛和呼吸困难反复发作前来就诊。心电图初步检查显示前间隔导联ST段抬高。患者接受了左右心导管检查，结果显示左前降支严重狭窄并伴有心源性休克表现。手术过程中患者需要使用经皮左心室辅助装置进行机械循环支持；由于患者双侧股动脉存在外周动脉疾病，故通过经腋动脉途径置入该装置。患者临床病程复杂，但临床情况逐渐改善，经皮左心室辅助装置被移除。装置移除约六周后，患者左肩部前方胸壁出现大量积液。影像学检查显示左锁骨下动脉远端PSA破裂。患者被迅速送往导管室，在PSA部位置入了覆膜支架。再次血管造影显示左锁骨下动脉血流顺畅，进入腋动脉，无造影剂外渗至胸壁。
