Acute prosthetic vascular graft distortion in the subclavian region: A case report and a review of the literature
Keywords:Vascular graft, Pseudoaneurysm, Emergency operation, Complications
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.
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