Pseudoaneurysm at the origin of the vertebral artery, iatrogenic damage to the vessel in a patient with multiple diseases: a case report

INTRODUCTION: Iatrogenic injury is one of several potential injuries to the subclavian artery, often caused by complicated central venous catheterization. Endovascular intervention is the primary treatment option in such cases. Analyzing the medical literature, we found seven cases of iatrogenic pseudoaneurysms of the subclavian artery at the origin of the vertebral artery, with only one case occurring in a patient with multimorbidity. CASE REPORT: A 65-year-old man with multiple organ failure due to septic and hemorrhagic shock presented with a pseudoaneurysm of the left subclavian artery at the vertebral artery outlet on follow-up radiography. A right femoral artery puncture procedure was performed under a necessity protocol. The intervention consisted of implantation of a stent into the subclavian artery. A follow-up angiography from the left subclavian artery confirmed no inflow into the aneurysm. Interlock coil implantation into the right vertebral artery was performed due to the retrograde inflow seen at late stage on angiography into the pseudoaneurysm. The success of the procedure was confirmed by follow-up angiography. DISCUSSION: Percutaneous central venous access is a frequently used procedure that is associated with several complications. One of the complications presented by the patient described is arterial vessel damage leading to pseudoaneurysm formation. Endovascular techniques allow, as in the case described, for the effective and minimally invasive management of such complications. CONCLUSIONS: The patient presented herein suffered an iatrogenic injury to the subclavian artery due to implantation of a vascular access to the central vein.