A large vertebral artery pseudoaneurysm due to percutaneous internal jugular vein cannulation

Excerpt

A 60-year-old man presented with an exacerbation of pulmonary edema, pneumonia, and lethargy. The patient had undergone attempted hemodialysis catheter placement in the right internal jugular vein (IJV) without ultrasonographic guidance. During the procedure, the patient developed increased stupor with a pulse of 30 beats per min and a blood pressure of 50/30 mmHg. Emergency cardiopulmonary resuscitation was performed. Chest x-ray imaging showed a bulging contour at the right paratracheal area with supra-mediastinal widening (Fig. 1a). On chest computed tomography (CT), a large pseudoaneurysm was identified at the right-side supra-mediastinum with surrounding hematoma. The pseudoaneurysm originated from the proximal right vertebral artery (VA) (Fig. 1b). Selective right subclavian angiography confirmed a large pseudoaneurysm of the proximal portion of the right VA. Three metal coils were deployed to occlude the proximal right VA. Then, a 10 × 25 mm balloon-expandable stent graft was deployed into the right subclavian artery (SCA) across the VA origin. After the procedure, angiography revealed no filling of the pseudoaneurysm and patency of the right SCA.

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