Endovascular treatment of subclavian artery injury with a complex post-traumatic fistula: Case report
| Autor: | Adriana Buechner de Freitas Brandão, Fabiano Luiz Erzinger, Thaís Duarte Baião Pessoa, Filipe Carlos Caron, Walter Junior Boim de Araujo, Afonso Henrique Venco Teixeira da Cunha, Viviane Gomes Milgioransa Ruggeri, Camila de Almeida Mazzoni |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
RD1-811 Fistula medicine.medical_treatment Arteriovenous fistula Case Report Critical Care and Intensive Care Medicine Trauma 03 medical and health sciences Embolization 0302 clinical medicine medicine.artery medicine Orthopedics and Sports Medicine Internal jugular vein 030222 orthopedics medicine.diagnostic_test business.industry Microcoils Stent 030208 emergency & critical care medicine Encapsulated stent graft medicine.disease Surgery Endovascular procedures Thyrocervical trunk Angiography Emergency Medicine Gunshot wound business |
| Zdroj: | Trauma Case Reports, Vol 32, Iss, Pp 100400-(2021) Trauma Case Reports |
| ISSN: | 2352-6440 |
| Popis: | Background Endovascular treatment in trauma is a promising strategy to reduce perioperative morbidity and mortality. We report the case of a gunshot wound causing an initially undiagnosed subclavian artery injury, with delayed progression to a complex, difficult-to-manage arteriovenous (AV) fistula. Placement of an encapsulated endovascular stent graft resolved the primary lesion, but persistent cervical arteriovenous communications were only repaired after multiple, sequential embolization procedures. Report A 25-year-old male sustained a gunshot wound to the right neck. Initial treatment failed to identify any vascular injury, and the patient was discharged. Three weeks later, he presented to our facility with headache and a palpable right-sided cervical thrill. Arteriography showed contrast extravasation from the right subclavian artery and an AV fistula with the ipsilateral internal jugular vein. The arterial injury was repaired with an encapsulated stent graft, but residual contrast leak persisted on follow-up angiography. Three months after the first intervention, cervical thrill was still present; a right vertebral–right internal jugular AV fistula was identified and repaired by distal coil embolization. One month later, persistent symptoms prompted repeat arteriography, which again identified contrast extravasation, now involving the thyrocervical trunk. Selective thyrocervical embolization was ultimately successful, with resolution of symptoms and no further evidence of contrast leak. Conclusion Delayed management of neck trauma can be challenging due to neovascularization, which hinders open repair in this delicate region. Post-traumatic arteriovenous fistulas are thus a particularly fearsome complication, and can be very difficult to approach; as in our patient, multiple interventions may be required. This case highlights the importance of detecting vascular trauma as early as possible, as a delay in diagnosis can hinder treatment and eventuate challenging late complications. Further studies are needed to demonstrate the long-term benefits of endovascular management of complex vascular injuries of the neck region. Highlights • Endovascular treatment of arterial trauma can reduce early morbidity and mortality. • Late diagnosis of vascular trauma can be associated with arteriovenous fistula. • Post-traumatic repair of arteriovenous fistula can be challenging in the cervical region and require multiple interventions. • Endovascular approaches can be an option where open dissection is challenging. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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