Background: Axillary artery (AA) injury caused by orthopedic trauma is relative uncommon but gathers
a high rate of morbidity. Endovascular approach gains popularity in management of AA injury although
evidence is still limited.
Methods: We report a case of percutaneous treatment of AA pseudoaneurysm caused by recurrent
shoulder dislocation in a patient with COVID-19.
Results: A 67-year-old female was admitted with recurrent dislocation of left shoulder provoked by
accidental fall one week ago. Two unsuccessful attempts for closed reduction of anterior dislocation
was performed in outside hospital. At admission CT-scan revealed posterior shoulder dislocation and
large axillary hematoma. There were no signs of acute limb ischemia. The third attempt of reduction was
performed by orthopedic surgeon. After the procedure expansion of axillary hematoma was observed and
hemoglobin decreased from 7.9 to 6.0 g/dL despite transfusion of 2 units of red blood cells concentrate.
Vascular injury was suspected by consulting vascular surgeon and duplex ultrasound demonstrated
2.2x1.4 cm AA pseudoaneurysm. Meanwhile, patient developed respiratory failure and result of PCR
was positive for SARS-cov-2. We decided to treat the arterial injury percutaneously. Angiography
demonstrated AA injury in segment II with active contrast extravasation. The self-expandable stentgraft
was successfully implanted via femoral access and patient transferred to dedicated COVID-19
facility. Postoperative evolution was complicated by infection of axillary hematoma, that required
surgical drainage. At two-month CT-angiography confirmed patency of stent-graft and exclusion of
pseudoaneurysm.
Conclusions: Endovascular repair represents a feasible option for treatment of AA pseudoaneurysm
especially in patients with severe comorbidities.