Abstract

In this article, we present a case of hybrid procedure in which a left subclavian artery pseudoaneurysm and arteriovenous fistula (AVF) by shrapnel
injury was treated by endovascular procedure following an unsuccessful surgery. The patient who previously underwent emergent left femoral
artery graft interposition due to shrapnel injury was referred to our department with a palpable mass starting from the left clavicle region to the
arm and severe edema in his left upper limb. Computed tomography angiography (CTA) and peripheral arteriography (PAG) revealed a subclavian
artery pseudoaneurysm and AVF. Pseudoaneurysm and AVF was repaired. Hematoma was evacuated. Repeated PAG showed extravasation with a
persistent AVF. A stent graft was deployed into the subclavian artery. The patient was discharged without any complication. Follow-up CTA showed
subclavian artery patency. In conclusion, endovascular interventions can be a treatment of choice as a hybrid procedure after an incomplete surgery
or in high-risk patients owing to its easy periprocedural access and low risk.

Key words: Arterial injury; endovascular; stent graft; subclavian artery