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Pseudoaneurysm formation following a traumatic wrist laceration

Published online by Cambridge University Press:  11 May 2015

Naveen Poonai ,
Rodrick Lim  and
Tim Lynch
Naveen Poonai*
Affiliation:
Department of Paediatrics, University of Western Ontario, London Health Sciences Centre, Children's Hospital of Western Ontario, London, ON
Rodrick Lim
Affiliation:
Department of Paediatrics, University of Western Ontario, London Health Sciences Centre, Children's Hospital of Western Ontario, London, ON
Tim Lynch
Affiliation:
Department of Paediatrics, University of Western Ontario, London Health Sciences Centre, Children's Hospital of Western Ontario, London, ON
*
London Health Sciences Centre, Victoria Hospital, Room E1-110, 800 Commissioners Road East, London, ON N6A 2V5; [email protected]

Abstract

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Pseudoaneurysms occur secondary to partial disruption of the arterial wall. They are a commonly described complication of arterial injury, with penetrating injury and iatrogenic arterial catheterization being the most common etiologies in children. Many present weeks to months after the injury, and the initial vascular injury is often missed. The complications of pseudoaneurysm, which include thromboembolism, neurapraxia, and compartment syndrome, underscore the importance of early recognition and management. Definitive therapy consists of ultrasound-guided compression or resection and possible graft interposition. We describe a case of pseudoaneurysm formation in the radial artery of an adolescent girl 6weeks following a penetrating injury. The patient’s injury was complicated by sensory and motor deficits consistent with ulnar nerve compression. This case attests to the importance of adequately ruling out arterial injury in penetrating injury and close followup if the history is suggestive. In addition, a high index of suspicion is warranted to facilitate imaging of a pulsatile mass to avoid confusion of a thrombosed artery with an abscess.

Keywords

pseudoaneurysmradial artery
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 1 , January 2011 , pp. 48 - 52
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Gudena, R, Khetan, N. Swelling of volar aspect of the wrist. Postgrad Med J 2005;81:e9, e11.CrossRefGoogle ScholarPubMed
2.Levis, JT, Garmel, GM. Radial artery pseudoaneurysm formation after cat bite to the wrist. Ann Emerg Med 2008;51:668–70.CrossRefGoogle ScholarPubMed
3.Noguchi, M, Hazama, S, Tsukasaki, S, et al. Iatrogenic pseudoaneurysm in a hemodialysis patient: the hidden hazard of a high radial artery origin. Heart Vessels 2004;19:98–100.CrossRefGoogle Scholar
4.Harkin, DW, Connolly, D, Chandrasekar, R, et al. Radial artery mycotic pseudoaneurysm in a haemophiliac: a potentially fatal complication of arterial catheterization. Haemophilia 2002;8:721–4.CrossRefGoogle Scholar
5.Fields, JM, Saluja, S, Schwartz, DS, et al. Hemophilia presenting in an infant as a radial artery pseudoaneurysm following arterial puncture. Pediatr Radiol 1997;27:763–4.CrossRefGoogle Scholar
6.Singh, S, Riaz, M, Wilmshurst, A, et al. Radial artery aneurysm in a case of neurofibromatosis. Br J Plast Surg 1998;51:564–5.Google Scholar
7.Reus, M, Vásquez, V, Alonso, J, et al. Treatment of a radial artery pseudoaneurysm with ultrasond-guided percutaneous thrombin injection in a patient with Beháet’s syndrome. J Clin Ultrasound 2003;31:440–4.Google Scholar
8.Dzepina, I, Unusic, J, Mijatovic, D, et al. Pseudoaneurysms of the branchial artery following venipuncture in infants. Pediatr Surg Int 2004;20:594–7.Google Scholar
9.Rich, NM, Hobson, RW 2nd, Collins, GJ Jr.Traumatic arteriovenous fistulas and false aneurysms: a review of 558 lesions. Surgery 1975;78:817–28.Google ScholarPubMed
10.Cozzi, D, Morini, F, Casati, A, et al. Radial artery pseudoaneurysm successfully treated by compression bandage. Arch Dis Child 2003;88:165–6.Google Scholar
11.Robbs, JV, Naidoo, KS. Nerve compression injuries due to traumatic false aneurysm. Ann Surg 1984;200:80–2.Google Scholar
12.Yilmaz, AT, Arslan, M, Demirkiliç, U, et al. Missed arterial injuries in military patients. Am J Surg 1997;173:110–4.Google Scholar
13.Rimoldi, RL, Gogan, WJ, Koulisis, CW, et al. Pseudoaneurysm of the radial artery as a cause of a late compartment syndrome. Clin Orthop Relat Res 1990;251:263–5.CrossRefGoogle Scholar
14.Ganchi, PA, Wilhelmi, BJ, Fujita, K, et al. Ruptured pseudoaneurysm complicating an infected radial artery catheter: case report and review of the literature. Ann Plast Surg 2001;46:647–50.Google Scholar
15.Yetkin, U, Gurbuz, A. Post-traumatic pseudoaneurysm of the brachial artery and its surgical treatment. Tex Heart Inst J 2003;30:293–7.Google ScholarPubMed
16.Hajarizadeh, H, LaRosa, C, Cardullo, P, et al. Ultrasoundguided compression of iatrogenic femoral pseudoaneurysm failure, recurrence, and long-term results. J Vasc Surg 1995;22:425–30.Google Scholar
17.Pelchovitz, DJ, Cahill, AM, Baskin, KM, et al. Pseudoaneurysm in children: diagnosis and interventional management. Pediatr Radiol 2005;35:434–9.Google Scholar
18.Landau, D, Schreiber, R, Szendro, G, et al. Brachial artery pseudoaneurysm in a premature infant. Arch Dis Child Fetal Neonatal Ed 2003;88:F152-3.Google Scholar
19.Krueger, K, Zaehringer, M, Strohe, D, et al. Postcatheterization pseudoaneurysms: results of US-guided percutaneous thrombin injection in 240 patients. Radiology 2005;236:1104–10.Google Scholar
20.Lennox, A, Griffin, M, Nicolaides, A, et al. Regarding percutaneous ultrasound guided thrombin injection: a new method for treating post-catheterization femoral pseudoaneurysms. J Vasc Surg 1998;28:1120–1.Google Scholar
21.Elford, J, Burrell, C, Freeman, S, et al. Human thrombin injection for the percutaneous treatment of iatrogenic pseudoaneurysms. Cardiovasc Intervent Radiol 2002;25:115–8.CrossRefGoogle ScholarPubMed
22.Frush, DP, Paulson, EK, O’Laughlin, MP. Successful sonographically guided thrombin injection in an infant with a femoral artery pseudoaneurysm. AJR Am J Roentgenol 2000;175:485–7.Google Scholar
23.Pezzullo, JA, Wallach, MT. Successful percutaneous thrombin injection of a brachial artery pseudoaneurysm in a neonate. AJR Am J Roentgenol 2002;178:244–5.CrossRefGoogle ScholarPubMed
24.Zitsman, JL. Pseudoaneurysm after penetrating trauma in children and adolescents. J Pediatr Surg 1998;33:1574–7.CrossRefGoogle ScholarPubMed