Acute prosthetic vascular graft distortion in the subclavian region: A case report and a review of the literature

Abstract

A 68-year-old male patient was admitted to the emergency department with complaints of sudden swelling under his right clavicle. He had undergone right axillo-femoral and femoro-femoral crossover bypasses 1.5 months ago due to peripheral artery disease. The subclavicular swelling had started one day ago. Physical examination revealed a pulsatile mass expanding from under the right clavicle towards the right breast. In auscultation, a murmur was heard on the mass and the patient was hospitalized with a diagnosis of pseudoaneurysm. Doppler ultrasonography revealed a 10x10 cm pseudoaneurysm sac in the right subclavian area. Hemoglobin level had decreased to 5.9 mg/dL. 2 units of erythrocyte suspension was transfused, after which the patient was operated emergently. During the operation, hemorrhage from the proximal and distal subclavian arteries was controlled with a fogarty catheter advanced to the subclavian artery via the brachial artery and axillo femoral graft. When the pseudo-aneurysm sac was incised, the synthetic vascular graft between the right axillary and right femoral arteries was observed to have dislocated distal to the axillary anastomosis area by approximately 1 cm. A new graft interposition was performed after resecting the torn synthetic graft section. The patient was discharged after an uneventful postoperative period.

Keywords

• Vascular graft,Pseudoaneurysm,Emergency operation,Complications

Subklavian bölgede akut prostetik vasküler greft distorsiyonu: Literatürün gözden geçirilmesi ve bir olgu sunumu

Öz

68 yaşında erkek hasta sağ klavikula altında ani başlayan şişlik ile acil servise başvurdu. Anamnezinde hastaya periferik arter hastalığı nedeniyle 1,5 ay önce sağ aksillo-femoral ve femoro-femoral crossover bypass yapıldığı öğrenildi. Subkavikular bölgede kolun aşırı yukarı ve geriye doğru gerilme hareketi sonrası aniden başlayan ve giderek artış gösteren şişliği vardı. Fizik muayenede sağ klavikula altından başlayan koltuk altına ve sağ memeye doğru yayılım gösteren pulsatile kitle tespit edildi. Oskültasyonda kitle üzerinde üfürüm duyuldu ve pseudoanevrizma ön tanısıyla yatırıldı. Acil şartlarda damar cerrahı tarafından yatak başı yapılan Doppler Ultrasonografide subklavian bölgedeki şişliğin pseudoanevrizma kesesi olduğu ve yaklaşık boyutunun 10x10 cm olduğu tespit edildi. Acil rutin kan tetkiklerinde Hemoglobin seviyesi 5,9’e kadar düşmüştü. Bunun üzerine acil kan hazırlığının ardından 2 ünite eritrosit süspansiyonu verildikten sonra acil operasyona alındı. Hastanın proximal ve distal subklavian arterdeki kanama kontrolü brakial arter ve aksillo-femoral greft yoluyla subklavian artere gönderilen fogarty kateteri ile sağlandı. Pseudoanevrizma kesesi açıldığı zaman sağ aksiller arter ile sağ femoral arter arasındaki sentetik vasküler greftin aksiller anastomoz alanına yaklaşık 1 cm mesafeden ayrılmış olduğu görüldü. Yırtılmış olan sentetik greft bölümü rezeke edilerek yeni bir greft interpozisyonu yapıldı. Postoperatif dönemde problemi olmayan hasta şifa ile taburcu edildi.

Anahtar Kelimeler

• Vasküler greft,Pseudoanevrizma,Acil operasyon,Komplikasyonlar

Kaynakça

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