Pulmonary artery pseudoaneurysm after Swan-Ganz catheterization: a case presentation and review of literature.
BACKGROUND
The Swan-Ganz catheter for pulmonary artery (PA) cannulation was introduced in 1970 and has been utilized in the management of critically ill and cardiac patients. Although the routine use of this catheter has not been associated with better patient outcomes in prospective randomized trials, their ability to provide crucial hemodynamic measurements and the ease of bedside insertion makes them valuable in certain complex clinical scenarios. However, Swan-Ganz catheter insertion is not without complications. PA injury is the most serious complication suspected by the occurrence of hemoptysis after the procedure. We present a case of PA injury with pseudoaneurysm formation after Swan-Ganz catheterization along with a comprehensive review of literature.


METHODS
We reviewed all PubMed/Medline indexed articles published between 1993-2013, reporting the development of PA pseudoaneurysm after Swan-Ganz catheter use. Cases were analyzed with specific reference to patient demographics, indication for Swan-Ganz insertion, initial presenting symptom, duration between insertion and first evidence of PA injury, inciting event, site of pseudoaneurysm, treatment and outcome.


RESULTS
Forty-one patients were identified from 27 papers. In the reviewed population, 87.8% were older than 60 years of age and 82.9% were females. Fifty-one percent of the patients had an episode of hemoptysis on the day of Swan-Ganz catheter insertion. Ninety-seven percent of the patients had PA pseudoaneurysm in the right pulmonary circulation. The admission-to-discharge mortality rate in the reviewed cohort was 15%. Cause of death in 22% of the cases was hemoptysis, while non-catheter related complications were responsible for the remaining deaths.


CONCLUSIONS
PA injury is a feared complication after Swan-Ganz catheterization and can be fatal. In patients who develop massive or recurrent hemoptysis after Swan-Ganz catheter use, PA injury must be considered and airway protection should be employed along with appropriate catheter based or surgical interventions.
Florida Gulf to Bay Anesthesiology, USA.
Madhan
M
Nellaiyappan
Internal Medicine Department, Mercy Medical Center, USA hesham_omar2003@yahoo.com.
Hesham R
HR
Omar
Oklahoma pain physicians, Oklahoma City, USA.
Rafael
R
Justiz
Florida Gulf to Bay Anesthesiology, USA.
Collin
C
Sprenker
Tampa General Hospital, USA.
Enrico M
EM
Camporesi
Florida Gulf to Bay Anesthesiology, USA Anesthesia Department and CEO Florida Gulf to Bay Anesthesiology Associates, Tampa General Hospital, Tampa, Florida, USA.
Devanand
D
Mangar
D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology*; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects*; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D011651:Pulmonary Artery; D014057:Tomography, X-Ray Computed
Pulmonary artery pseudoaneurysm; Swan-Ganz catheter; pulmonary artery injury; pulmonary artery rupture; right heart catheterization