Usage of a percutaneous closure device to repair an iatrogenic subclavian artery injury.

OBJECTIVES: Inadvertent subclavian artery cannulation during attempted subclavian central venous access is more likely to occur during rushed trauma resuscitations when anatomic landmarks are used for placement. Traditional supraclavicular and infraclavicular approaches for direct repair of the resultant arteriotomy are painful, morbid procedures that should be replaced with more minimally invasive techniques. METHODS: This case report describes the usage of a percutaneous suture-mediated device (Perclose Proglide, Abbott Laboratories) to repair an iatrogenic subclavian artery arteriotomy. RESULTS: Two patients had their injuries successfully repaired using a percutaneous closure device. CONCLUSIONS: The use of a percutaneous closure device to repair iatrogenic subclavian artery injuries is a safe and effective method of repair that precludes a more invasive exposure and repair.

Microsurgical vascular bypass in the setting of pediatric limb length discrepancy.

Management of pediatric iatrogenic arterial occlusions can be challenging clinically, leading to chronic complications such as claudication and limb length discrepancy. We report the case of a 6-month-old female patient who had experienced iatrogenic right external iliac and common femoral arterial occlusion. At the age of 8 years, she had developed claudication and a limb length discrepancy of 3.2 cm. She underwent common iliac artery to superficial femoral artery and profunda artery bypass via a branched autologous reverse great saphenous vein using microsurgical techniques for the distal anastomoses. In the present report, we have focused on the musculoskeletal improvements, benefits of microsurgery in pediatric vessels, and maximization of epiphyseal perfusion.

Mycobacterium abscessus infection in a burn intensive care unit patient.

BACKGROUND: Infection is the leading cause of death in burn patients. Historically, this was due to burn wound sepsis but pneumonia has now emerged as the most common source. In light of the increasing incidence of multi-drug-resistant organisms, the description of rare infections is paramount in continuing the fight against deadly pathogens. We aim to describe the second case of non-tuberculous mycobacterium (NTM) reported in a burn patient. Difficulties in diagnosis and management will also be highlighted. METHODS: A 70-y-old Caucasian female, with a past medical history for type 2 diabetes mellitus, was transferred to our facility after a house fire. She had sustained a 28% total body surface area (TBSA) flame burn to her neck, torso, and all four extremities. She underwent excision and grafting on hospital day five with multiple subsequent attempts at excision and grafting due to graft loss. On hospital day 14, a tracheostomy was performed. Her hospital course was complicated by ongoing respiratory failure, renal injury, and sepsis. RESULTS: Mycobacterium abscessus was found on blood cultures from central venous catheters and arterial line catheters as well as on tracheal aspirate and bronchoalveolar lavage (BAL) on hospital day 86. Imaging then revealed multiple pulmonary nodular densities with patchy ground-glass opacities. After multiple adjustments to the antibiotic regimen, tigecycline, clarithromycin, and cefoxitin therapy was started. She remained on this regimen for almost 4 wks. Her other infections included Acinetobacter baumanii treated with tobramycin and colistin, as well as Candida albicans for which she received fluconazole. Ultimately, her clinical state worsened leading to withdrawal of care. CONCLUSIONS: Sepsis NTM is rare in burn patients with only one other case described in the English-language literature. Both cases reflect differences in diagnosis and management. This highlights the need to discuss rare infections in an attempt to broaden the clinician's awareness of such pathogens, as well as to collaborate to form a consensus about their management.