Hemophilia presenting in an infant as a radial artery pseudoaneurysm following arterial puncture

Surgical Reconstruction of Traumatic Pseudoaneurysm of Palmar Arch Caused by Blunt Trauma

Although rare, pseudoaneurysms (PAs) of the palmar arch are mostly considered benign. However, they can cause severe complications if left untreated or misdiagnosed. There are a few data on traumatic PAs of the palmar arch, particularly those most commonly caused by penetrating hand injuries. However, PAs caused by blunt trauma are more insidious in onset, presenting as a painful pulsatile mass in the palmar area of the hand, and require prompt diagnosis and management to avoid catastrophic sequelae. Our case is the first study to describe a patient with traumatic PA of the palmar arch caused by blunt trauma that was treated with surgical reconstruction and venous bypass interposition.

Enormous Articular Hemorrhage Following Arthroscopy, Total Joint Replacement and other Surgical Operations in Hemophilic Patients due to Arterial Pseudoaneurysms: Diagnosis and Treatment

Pseudoaneurysms in hemophilic patients are unusual. We must have a suspicion when the patient has suffered an arterial trauma (following arthroscopy, total joint replacement and other surgical operations). Pseudoaneurysms may take place in any anatomical zone where there has been trauma. The diagnosis must be verified by duplex ultrasonography (US), standard angiogram, computed tomography angiogram or magnetic resonance angiography. There are diverse alternatives for the management of arterial pseudoaneurysms. Small pseudoaneurysms can be solved with conservative noninterventional management. It includes outside pressing, US probe pressing or US-guided thrombin injections. In larger pseudoaneurysms, endovascular methods, such as coil embolization, are now preferred. If the aforesaid methods are unsuccessful, standard surgical management with simple ligation or arterial reconstruction must be carried out. We must suspect a pseudoaneurysm when, following an arterial trauma, there is severe bleeding that does not stop with appropriate management with intravenous injection of the insufficient coagulation factor. The diagnosis has to be verified by imaging. Endovascular methods, such as coil embolization, are now preferred by the majority of physicians. The diagnosis and managment of an arterial pseudoaneurysm must be carried promptly to avert adverse events.

Severe haemophilia A in a neonate presenting as haemopneumothorax after tracheo-oesophageal fistula-oesophageal atresia repair

A male infant with oesophageal atresia and distal tracheo-oesophageal fistula (TEF type C) underwent right thoracotomy and transpleural repair of TEF on day 4 of life. He did not have a family history of coagulation disorders. A preoperative finding of prolonged partial thromboplastin time (PTT)>200 s was overlooked, and he went to surgery. There were no concerns with haemostasis prior to and even during the operation. The prolonged PTT was treated with one 10 mL/kg dose of fresh frozen plasma in the immediate postoperative period. On the fourth postoperative day, the infant developed a right haemopneumothorax, requiring fresh frozen plasma and packed cell transfusions. He was subsequently diagnosed with severe haemophilia A due to intron 22 inversion in the factor VIII gene, with factor VIII level <0.01 IU/mL.

Pseudoaneurysm formation following a traumatic wrist laceration

Pseudoaneurysms occur secondary to partial disruption of the arterial wall. They are a commonly described complication of arterial injury, with penetrating injury and iatrogenic arterial catheterization being the most common etiologies in children. Many present weeks to months after the injury, and the initial vascular injury is often missed. The complications of pseudoaneurysm, which include thromboembolism, neurapraxia, and compartment syndrome, underscore the importance of early recognition and management. Definitive therapy consists of ultrasound-guided compression or resection and possible graft interposition. We describe a case of pseudoaneurysm formation in the radial artery of an adolescent girl 6weeks following a penetrating injury. The patient’s injury was complicated by sensory and motor deficits consistent with ulnar nerve compression. This case attests to the importance of adequately ruling out arterial injury in penetrating injury and close followup if the history is suggestive. In addition, a high index of suspicion is warranted to facilitate imaging of a pulsatile mass to avoid confusion of a thrombosed artery with an abscess.

Effective compression bandage for repair of a complicated radial artery pseudoaneurysm

We describe a 10-week-old hemophilic infant who developed a large-sized pseudoaneurysm of the radial artery after arterial puncture. Based on our previous experience, compression bandage was elected as first-line treatment. The clinical course was complicated by skin ulceration. However, compression bandage was continued, and complete thrombosis of the pseudoaneurysm occurred after 4 weeks of treatment, preserving arterial patency. Bedside clot evacuation and enzymatic debridement promoted rapid wound healing with negligible scar formation. Compression bandage is a safe and valuable measure for repair of radial artery pseudoaneurysm, even in patients with clotting disorders. Professionals are encouraged to consider the benefit of such an artery-sparing treatment option.

Spontaneous false aneurysm of the gastroduodenal artery in a hemophilic patient ruptured into the duodenum: case report

Pseudoaneurysms of the splanchnic arteries are rare causes of gastrointestinal bleeding. We report a case of a spontaneous gastroduodenal artery false aneurysm ruptured into the duodenum in a patient with hemophilia. The diagnosis was confirmed by spiral computed tomography and magnetic resonance angiography. The patient died from massive gastrointestinal bleeding.

Brachial Artery Pseudoaneurysm in a 6-Week-Old Infant

Trauma to the wall of an artery may lead to the development of a pseudoaneurysm. There are infrequent case reports of children who have developed pseudoaneurysms after vascular access attempts. The options for management are limited in children and even more so in neonates. We describe the presentation and management of a 6-week-old infant who had attempts at insertion of an intravenous catheter as a newborn. She presented with an enlarging mass of the right upper extremity with no palpable radial pulse on examination. Workup included radiographs, Doppler ultrasound, and magnetic resonance imaging that established the diagnosis of pseudoaneurysm of the brachial artery. She underwent a repair of the right brachial artery by identifying the site of the arterial injury and oversewing the defect in the wall. Intraoperatively, she had good arterial flow with a return of the radial pulse. The patient did well immediately postoperatively and has been followed for more than a year with normal pulses and growth of the upper extremity. Patients that have had previous attempts at vascular access and subsequently develop a mass in the area of puncture should be worked up for the potential of a pseudoaneurysm. Doppler ultrasound and magnetic resonance imaging may help with diagnosis. Primary repair is advocated in this injury to ensure adequate growth of the limb.

Radial artery mycotic pseudoaneurysm in a haemophiliac: a potentially fatal complication of arterial catheterization

We present a case of radial artery pseudoaneurysm formation in a haemophiliac patient, which developed after radial artery cannulation. Haematologists and anaesthetists should be aware of this potentially fatal condition.