Endovascular Repair of Iatrogenic Subclavian Artery Perforations Using Stent-Graft: Report of a Case

Purpose: To report a case of iatrogenic subclavian artery perforation treated with Vascular Stent-Graft.Case Report: A 54-year-old married male was admitted to Chung Shin Hospital with the chief complaint of severe sharp pain in his right clavicular region after a traffic accident on April 6, 2009. Fracture of the right clavicle was diagnosed after X-ray examination. The patient immediately underwent open reduction and internal fixation (ORIF) with a Kirschner wire with an uneventful postoperative course. The K-wire was removed 4 weeks later, on May 8, 2009. However, pain in the right clavicular area recurred and lasted for almost one month. A repeated X-ray was showed ”Non-union of the right clavicular fracture”. The patient underwent a ”redo” open reduction (ORIF) on June 2, 2009. During the operation, the patient sustained an accidental right subclavian artery injury resulting in active bleeding and pseudo-aneurysm formation there of; he was transferred to Chung Shan Medical University Hospital, and after CT angiography, he underwent endovascular repair of his right subclavian artery perforation.Results: The endovascular prosthesis (Fluency Plus Vascular Stent Graft 10 60 mm, Bard®) was successfully deployed at the site of the pseudoaneurysm via ipsilateral femoral artery access. No signs of endograft occlusion, migration, deformation, or fracrture have been observed during the follow-up period of eleven months.Conclusion: Endovascular repair of the subclavian artery injury may be an acceptable alternative to other more invasive modes of therapy. A sufficiently long follow-up, however, is needed to determine if the design of this endograft will resist compression in this vascular location.