Pseudoaneurysm of a branch of left internal mammary artery: a late and potentially fatal complication after redo-sternotomy

Abstract

Post-sternotomy pseudoaneurysms of the internal mammary arteries (IMAs) and their branches are rare and often present with rupture-associated haemothorax and haemodynamic instability. In those cases, urgent surgical correction or embolization can be the treatment of choice. Traumatic chest injuries might lead to IMA branch injury as well; after cardiac surgery, injuries to these branches during sternal closure can be an extremely rare cause of pseudoaneurysm. We describe the case of a 78-year old lady with a left IMA branch pseudoaneurysm, arising from left sternal edge a few weeks after redo-sternotomy for mitral valve surgery. We also describe its non-surgical successful repair.

Ultrasound diagnosis of a pseudoaneurysm of the internal right mammary artery

“…The main causes of traumatic IMA injuries are motorcycle and automobile accidents. Most frequently, these types of pseudoaneurysm are linked to iatrogenic complications from surgeries such as sternotomies, coronary artery bypass grafting, pacemaker placement, and central venous access [ 11 , 12 ]. Diagnosis is often made with a contrast-enhanced chest CT scan, and later eventually confirmed with angiography.…”

A false aneurysm of internal mammary artery: A case report

“…[1][2][3] One should suspect the diagnosis of a FA of the IMA, particularly in case of a parasternal mass. [11] Radiological imaging methods such as CT, MRI, and angiographic modalities including CTA, magnetic resonance angiography (MRA) and catheter angiography can visualize FAs of the IMA. Proper imaging method is selected based on several variables such as the cause of vascular damage, localization, size, and patient morbidity.…”

Hemorrhagic shock due to branch injury of the left internal thoracic artery two days after pericardiocentesis

“…In an analysis of 262 patients who underwent angiography before coronary artery bypass grafting (CABG) surgery, anomalies of the internal thoracic artery in the large side branch with a diameter greater than 30% of the LITA were present in 8.8% of patients [6]. Falconieri et al [7] reported on a patient with pseudoaneurysm of a branch of the LITA after cardiac surgery, and Kim et al [8] presented a case of post-CABG myocardial ischemia that was caused by an overgrown LITA side branch. However, there was no report of bleeding of the LITA branch due to pericardiocentesis.…”