A Rare Case of Iatrogenic Pseudoaneurysm of the Left Brachiocephalic Vein After Central Venous Catheterization Treated With Thrombin Injection

Abstract

Rupture of the central veins with venous pseudoaneurysm formation is an unusual complication of central venous catheterization. Only seven cases of brachiocephalic venous pseudoaneurysm have been reported in the literature (among these only one was secondary to central venous catheterization). Plain radiographic examination of the chest may show widening of the mediastinum, pleural effusion (haemothorax), and/or opacity overlying the hemithorax of the injured vein. Further evaluation using either computed tomography or magnetic resonance imaging can be performed. Venography is considered an important tool, especially when an intervention is planned. We present the first reported case of brachiocephalic vein pseudoaneurysm treated solely with thrombin injection. The imaging, other treatment options, and literature review of brachiocephalic venous pseudoaneurysm are also discussed.

Central venous catheterization–induced right brachiocephalic vein pseudoaneurysm: Successfully treated with stent-assisted coiling

“…Few case reports reported central venous catheterization or trauma-related left brachiocephalic vein pseudoaneurysm. 1–3 To our knowledge, limited right brachiocephalic vein pseudoaneurysm has not been reported except superior vena cava rupture after central catheterization via the left internal jugular vein. 4…”

“…Over the past few years, surgical repair of central vein pseudoaneurysm has been partly replaced by minimally invasive interventional treatments. [2][3][4] Several endovascular repair techniques could be applied, such as insertion of a covered stent graft, insertion of a self-expandable uncovered stent with or without coil packing, embolization solely with coiling, and intrasac thrombin injection.…”

“…In 2014, Elsaadany et al 3 reported the first case of brachiocephalic vein pseudoaneurysm treated with thrombin injection, which can be a good alternative option. However, thrombin injection may have potential risks of several complications.…”

Incidental diagnosis of a silent brachiocephalic vein aneurysm and its surgical treatment

“…Some cases in the literature with a specific type of aneurysm called pseudoaneurysm underwent endovascular treatment by uncovered endovascular flexible self-expanding stent placement with trans-stent coil embolization or thrombin injection. 22,23 A surgical treatment was chosen for our patient because she mainly needed open heart surgery for symptomatic severe tricuspid regurgitation with coronary artery disease. Without other surgical indication, we would have opted for a less invasive treatment using an endovascular approach.…”