Traumatic pseudoaneurysm in brachial artery after removal of a subdermal contraceptive implant

The frequency of invasive therapeutic procedures has increased as medicine evolves, and the number of complications related to them has increased as a consequence. Subdermal contraceptive implants (SCI) offer benefits for female contraception, but implant and removal are associated with a complication rate of around 3%. In this article, we report and discuss a case of traumatic brachial artery pseudoaneurysm after an attempt to remove an SCI, complicated by compression of the median nerve.

Keywords:
vascular injury; brachial artery; contraceptives

Authorship

Rafael Borges Monteiro

Hospital Municipal do Campo Limpo – HMCL, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil. Hospital Municipal do Campo LimpoBrasilSão Paulo, SP, BrasilHospital Municipal do Campo Limpo – HMCL, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil.

Patrick Bastos Metzger

Hospital Universitário Professor Edgard Santos, Salvador, BA, Brasil.Hospital Universitário Professor Edgard SantosBrasilSalvador, BA, BrasilHospital Universitário Professor Edgard Santos, Salvador, BA, Brasil.

http://orcid.org/0000-0002-1717-1370

Ariadne Bonachela de Moura

Centro Universitário das Américas – CAM, Curso de Medicina, São Paulo, SP, Brasil. Centro Universitário das AméricasBrasilSão Paulo, SP, BrasilCentro Universitário das Américas – CAM, Curso de Medicina, São Paulo, SP, Brasil.

http://orcid.org/0000-0001-8101-1016

Antonio Herculano Silva Filho

Beneficência Portuguesa de São Paulo, Departamento de Cirurgia Vascular, São Paulo, SP, Brasil. Beneficência Portuguesa de São PauloBrasilSão Paulo, SP, BrasilBeneficência Portuguesa de São Paulo, Departamento de Cirurgia Vascular, São Paulo, SP, Brasil.

Matheus Nogueira Campos

Arthur Suana de Brito

Mirella Prado Luengo

Universidade Anhembi Morumbi – UAM, São Paulo, SP, Brasil.Universidade Anhembi MorumbiBrasilSão Paulo, SP, BrasilUniversidade Anhembi Morumbi – UAM, São Paulo, SP, Brasil.

Maria Júlia Andrade Nascimento

Universidade Anhembi Morumbi – UAM, São Paulo, SP, Brasil.Universidade Anhembi MorumbiBrasilSão Paulo, SP, BrasilUniversidade Anhembi Morumbi – UAM, São Paulo, SP, Brasil.

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

CorrespondencePatrick Bastos Metzger Hospital Universitário Professor Edgard Santos Rua Augusto Viana, s/n - Canela CEP 40110-060 - Salvador (BA), Brasil Tel.: +55 (71) 99977-6356 E-mail: patrickvascular@gmail.com

Author informationRBM - Vascular surgeon, Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV); Team coordinator, Cirurgia Vascular, Hospital Municipal do Campo Limpo (HMCL); Assistant professor, Universidade Anhembi Morumbi (UAM). PBM - PhD in Medicina, Universidade de São Paulo (USP); Vascular and endovascular surgeon, SBACV; interventional radiologist from Colégio Brasileiro de Radiologia (CBR); vascular sonographer, CBR; primary physician, Hospital das Clínicas de Salvador (HUPES); Adjunct professor, Escola Bahiana de Medicina e Saúde Pública (EBMSP). ABM, MNC and ASB - Medical students, Centro Universitário das Américas (CAM). AHSF – Resident, Cirurgia Vascular, Hospital Beneficência Portuguesa de São Paulo (HBP). MPL and MJAN - Medical students, Universidade Anhembi Morumbi (UAM).

Author contributionsConception and design: RBM, PBM Analysis and interpretation: RBM, PBM Data collection: ABM, AHSF, MNC, ASB, MPL, MJAN Writing the article: ABM, RBM, AHSF, MNC, ASB, MPL, MJAN, PBM Critical revision of the article: PBM Final approval of the article*: RBM, PBM, ABM, AHSF, MNC, ASB, MPL, MJAN Statistical analysis: N/A. Overall responsibility: RBM, PBM *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

SCIMAGO INSTITUTIONS RANKINGS

Universidade Anhembi Morumbi – UAM, São Paulo, SP, Brasil.Universidade Anhembi MorumbiBrasilSão Paulo, SP, BrasilUniversidade Anhembi Morumbi – UAM, São Paulo, SP, Brasil.

Figures

Figures (2)

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Figure 1
(A) Large-volume hematoma in the distal third of the left arm. Note the medial incision in the mid third of the arm, made for the attempt to remove the subdermal contraceptive implant; (B) Open surgery to repair the brachial pseudoaneurysm. Complete removal of the hematoma, decompression of the nerve, and repair of the orifice in the artery; (C) Contraceptive implant after removal.

Thumbnail

Figure 2
(A) Preoperative longitudinal Duplex ultrasonography showing where the pseudoaneurysm interrupts the artery; (B) Turbulent “yin yang” flow in the pseudoaneurysm.

Figure 1 (A) Large-volume hematoma in the distal third of the left arm. Note the medial incision in the mid third of the arm, made for the attempt to remove the subdermal contraceptive implant; (B) Open surgery to repair the brachial pseudoaneurysm. Complete removal of the hematoma, decompression of the nerve, and repair of the orifice in the artery; (C) Contraceptive implant after removal.

Figure 2 (A) Preoperative longitudinal Duplex ultrasonography showing where the pseudoaneurysm interrupts the artery; (B) Turbulent “yin yang” flow in the pseudoaneurysm.

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Traumatic pseudoaneurysm in brachial artery after removal of a subdermal contraceptive implant

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[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.