锁骨下动脉假性动脉瘤(PSA)是高危经皮冠状动脉介入治疗(PCI)期间经腋窝Impella装置放置引起的罕见并发症。尽管Impella的使用越来越普遍,解决这一并发症的文献很少。该病例强调了锁骨下动脉PSA的现有证据有限,并强调了将其视为潜在风险的重要性。随着高风险PCI和Impella使用的普及,了解这种并发症对于早期发现和适当管理至关重要.一名62岁男性,既往有II型糖尿病病史,外周动脉疾病,高血压,慢性烟草使用表现为反复发作的劳力性胸痛和呼吸困难。最初的心电图检查显示前间隔导联ST段抬高。患者接受了左右两侧的心导管插入术,显示左前降支严重狭窄和心源性休克。在手术过程中,患者需要使用经皮左心室辅助装置进行机械循环支持;由于患者的双侧股动脉患有外周动脉疾病,因此通过经腋窝入路放置。病人有一个复杂的临床过程,但是病人的临床表现慢慢改善,移除经皮左心室辅助装置。移除装置大约六周后,患者在左肩前方的胸壁出现大量液体积聚。影像学显示左锁骨下动脉远端PSA破裂。患者被迅速带到导管插入实验室,并在PSA部位展开覆膜支架。重复血管造影显示,通过左锁骨下动脉进入腋窝动脉的血流很快,没有外渗到胸壁。
Subclavian artery pseudoaneurysm (PSA) is a rare complication arising from transaxillary Impella device placement during high-risk percutaneous coronary intervention (PCI). Despite the increasing prevalence of Impella use, literature addressing this complication is scarce. This case emphasizes the limited existing evidence on subclavian artery PSA and highlights the importance of recognizing it as a potential risk. With high-risk PCI and Impella use gaining popularity, understanding this complication is crucial for early detection and appropriate management. A 62-year-old male with a past medical history of type II diabetes mellitus, peripheral artery disease, hypertension, and chronic tobacco use presents with recurrent episodes of exertional chest pain and dyspnea. Initial workup with an electrocardiogram showed ST-segment elevations in the anteroseptal leads. The patient underwent right- and left-sided cardiac catheterization, which revealed severe stenosis of the left anterior descending artery and findings of cardiogenic shock. The patient required mechanical circulatory support with a percutaneous left ventricular assist device during the procedure; this was placed via transaxillary approach due to the patient having peripheral artery disease in bilateral femoral arteries. The patient had a complicated clinical course, but the patient\'s clinical picture slowly improved, and the percutaneous left ventricular assist device was removed. Roughly six weeks after the removal of the device, the patient developed a large fluid collection in the chest wall anterior to the left shoulder. Imaging revealed a ruptured left distal subclavian artery PSA. The patient was promptly taken to the catheterization laboratory and a covered stent was deployed over the site of the PSA. Repeat angiography revealed brisk flow through the left subclavian artery into the axillary artery with no extravasation into the chest wall.