Iatrogenic Venous Pseudoaneurysm: Case Report And Review Of The Literature

Abstract

Iatrogenic venous pseudoaneurysm following venipuncture is an extremely rare complication of a very common medical procedure. A review of the vascular surgical literature revealed that only two cases of venous pseudoaneurysm secondary to venipuncture have been reported in the past half-century. We report the case of a 64-year-old anticoagulated male with a 7-month history of right arm swelling after venipuncture. The patient, on warfarin therapy for chronic atrial fibrillation, described progressive swelling at a previous venipuncture site. He eventually underwent limited two-dimensional ultrasonography, performed for a suspected hematoma, revealing a 4.3 x 3.3 x 2.0 cm pseudoaneurysm of the right basilic vein. These findings were later confirmed by a formal venous duplex sonogram. Similar to other forms of aneurysm and focal vascular dilation, the risks of venous psuedoaneurysm include embolism, thrombosis, and the compression of adjacent structures. Although both thrombin injection and coil embolization have been described as nonsurgical treatment options for arterial pseudoaneurysms, surgical resection may be the most appropriate approach for those with a venous equivalent. The segment of basilic vein containing the pseudoaneurysm was resected. This case demonstrates the need for physicians to consider venous pseudoaneurysm as a possible complication of venipuncture in individuals undergoing anticoagulation therapy.

Blunt traumatic great saphenous vein pseudoaneurysm

“…Venography is the standard technique for diagnosing venous pseudoaneurysms. The usefulness of MRI, MRA, and duplex ultrasound is also reported . But MRI and MRA may not always accurately identify venous pseudoaneurysm .…”

“…Although arterial pseudoaneurysms are a frequent complication of arterial procedures, venous pseudoaneurysms are rare. They exact pathogenesis remains unclear, but most reported cases were iatrogenic and developed secondary to manipulation of the vascular structure . The potential noniatrogenic causes include trauma, intravenous drug abuse, inflammation, degeneration, and congenital abnormality …”

“…They exact pathogenesis remains unclear, but most reported cases were iatrogenic and developed secondary to manipulation of the vascular structure. 1 The potential noniatrogenic causes include trauma, intravenous drug abuse, inflammation, degeneration, and congenital abnormality. 2 Two case of great saphenous vein (GSV) pseudoaneurysm have been reported.…”

Iatrogenic Pseudoaneurysm of the Cephalic Vein: Case Report

“…Literatür bilgisi incelendiğinde, intravenöz işlem sonrası görü-len biri gerçek, ikisi ise yalancı olan iki adet üst ekstremite venöz anevrizma olgu sunumu bildirilmiştir 1,5,6 . Gerçek anevrizmanın olduğu olguda bizim olgumuza benzer şekilde, ağrı da eşlik ettiği için cerrahi rezeksiyon uygulanmıştır 1 .…”

“…Gerçek anevrizmanın olduğu olguda bizim olgumuza benzer şekilde, ağrı da eşlik ettiği için cerrahi rezeksiyon uygulanmıştır 1 . Diğer bir olguda, atriyal fibrilasyon nedeni ile oral antikoagülan kullanan hastanın basilik ven ponksiyonu sonrası gelişen psödo-anevrizmasına yine cerrahi rezeksyon uygulanmış ve bu tarz olgularda arteriyel psödoanevrizmalardan farklı olarak embolizasyon yöntemleri yerine cerrahi rezeksiyon önerilmiştir (6). Chakraborty ve arkadaşlarının yayınladıkları venöz psödoanev-rizma vakasında ise yine hastanın antikoagülan kullandığı ve ven pnksiyonu sonrası antekübital bölgede psödoanevrizma geliştiği rapor edilmiş ve hastaya koil embolizasyonu uygulanmıştır 5 .…”