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Kao et al. Vessel Plus 2018;2:18 I http://dx.doi.org/10.20517/2574-1209.2018.42 Page 3 of 5

A

B

Figure 3. (A) Angiography shows the pseudoaneurysm formation. (B) The endoprosthesis (GORE® VIABAHN® Endoprosthesis, W.L.
Gore and Associates, Inc. Flagstaff, AZ)

Right on transferal, emergent endovascular repair was scheduled, and an extravasation of contrast media
was detected on right axillary artery intra-operatively. A cover stent (GORE® VIABAHN® Endoprosthesis,
W.L. Gore and Associates, Inc. Flagstaff, AZ) with 8 mm in diameter and 5 cm in length was implanted
through right brachial artery to facilitate arterial repair. Postdilatation was done with Rival 8 mm balloon.
The pseudoanerysm was debrided after the endovascular procedure [Figures 3 and 4]. The patient was dis-
charged uneventfully within 2 weeks.

DISCUSSION
The complexity of anatomical structure of axillo-subclavian artery poses a potential risk for open surgical
approach. Not to mention that injuries of axillo-subclavian artery are uncommon, and therefore even sea-
[4]
soned surgeons have limited experience on approaching the field under active bleeding condition . Further-
more, the patients who suffer from such injuries might be too critically ill and thus not suitable for highly
[7]
invasive treatment . Under such circumstances, there is a growing trend of endovascular repair in axillo-
subclavian artery injuries [3,7-10] . Among such cases, iatrogenic-related injury accounts for 22.4%. Most of the
iatrogenic-related penetrating injuries of axillo-subclavian arteries cases are caused by venous catheteriza-
[3]
tion . Iatrogenic-related penetrating injuries to axillo-subclavian artery result in complications such as
pseudoaneurysm, AV fistula and dissection [3,11-13] .

Our case was rare, and there was no similar report in previous publication. It was a case of penetrating in-
jury to axillary artery by pigtail catheter insertion for chest wall hematoma. Pseudoaneurysm formation was
revealed with subsequent CT and angiogram evaluation. For injuries to the axillo-subclavian artery, there
were various kinds of endoprosthesis useful for repair. For the subgroup of penetrating injuries or iatrogenic