Reconstruction of Chest Wall after Extensive Chest Wall Necrosis Caused by Transcatheter Arterial Embolization of Bilateral Internal Mammary Arteries Injured by Cardiopulmonary Resuscitation—A Case Report

Transcatheter Arterial Embolization (TAE) is known to be effective for controlling severe hemorrhage caused by iatrogenic or blunt trauma. Out of more than 100 cases of TAE performed in our hospital, we have treated some cases of skin or muscle necrosis that resulted from embolization of the main arteries. In this study, we report the case of a patient with significant chest wall necrosis after TAE of the bilateral internal mammary arteries (IMAs). A 66-year-old male was transported to our hospital for loss of consciousness while playing golf. Cardiopulmonary resuscitation (CPR) was performed for cardiac arrest, which resulted in several rib fractures and mediastinal hematoma due to bilateral mammary artery injuries. Immediate TAE embolization was performed because of continuous hemorrhage. He was referred to our department 16 days after embolization due to the presentation of chest wall necrosis. Heart, lungs and diaphragm were exposed after surgical debridement under systemic anesthesia. We performed several operations to reconstruct the anterior chest wall. His spontaneous respiration returned, and is now controlled with a tracheostomy tube. Complete epithelialization was achieved, and he was transferred to another hospital for further rehabilitation. To the best of our knowledge, this is the first report of chest wall necrosis resulting from TAE of IMAs. Arterial embolization can cause widespread necrosis of bone, muscle and skin. Although treatment required an extended period, we managed to reconstruct the chest wall with multidisciplinary strategies.