Surgical emergency: rupture of infected brachial artery pseudoaneurysm

Description

A 53-year-old right hand dominant man with a significant medical history of intravenous heroin abuse for over 10 years. He admitted to last injecting heroin this morning into his right arm. Surgical history is significant for traumatic right-hand amputation 10 years ago and multiple right-arm debridements for chronic wound infections from active heroin use. Patient presented to the emergency department with a brisk pulsatile right upper arm bleed. On initial surgical consultation, the patient was found to be hypotensive and tachycardic. Manual pressure was held over a pseudoaneurysm that was noted to be bleeding (figure 1 and video 1). Blood pressure cuff was applied proximal to the bleeding site, and the patient was taken to the operating room for exploration.

Figure 1

Note the chronic infected wounds and deformed upper extremity from multiple surgical procedures and pre-existing trauma.

Video 1

Pulsatile...

http://ift.tt/2rBMuW8