Traumatic SCA injuries are reported in less than 5% of all traumatic arterial injury, less than 2% in penetrating injuries [1,3], or it occurs mainly as a result of central venous catheterization accidentally damaging the artery [4]. It can cause hemorrhage with a life-threatening, limb ischemia and false aneurysm. In child, there are only many cases described in literature.

Clinically, the pseudoaneurysm may be symptomatic or asymptomatic. There may be active bleeding through the wound, a palpable pulsatile supra-clavicular mass, signs of compression of surrounding structures (airway, esophagus, cervical sympathetic chain, or laryngeal nerve), or thrombosis and distal embolism with signs of ischemia [5].

Diagnosis is confirmed by imaging, which must be performed rapidly. CT scan can specify size and location of the pseudoaneurysm. It aids also in detecting related injuries that may not be noticed by other modalities (for example, angiography, which is confined to evaluating arterial structures). The conventional angiography has a significant advantage to perform the concurrent hemodynamic evaluation of a specific vascular channel, including identifying collateral vessels to determine donor artery expansion. Such evaluation is essential for management planning and feasibility of endovascular treatment [6].

Surgical repair has been performed as a treatment of choice. Various types of surgical approaches have been described in different literature, like midline sternotomy, anterolateral thoracotomy (trap door incision); the right SCA needs to be entirely open via extra-thoracic approach or median sternotomy [7]. To control the proximal injury, we can approach it by supra/infra-clavicular incision or median sternotomy; It depends on the location of the injury [7]. In our case, we opted for a combined approach, median sternotomy and clavicular incision, which is demonstrated by previous studies [8].

Recently, with the development of endovascular treatment, many endovascular repairs have been performed to prevent surgical complications, after careful selection of patients eligible for the technique. They might offer less invasive approach to this artery but possible limitations and controversies should be considered. Some contraindications are described, like inadequate distal or proximal landing zones, sustained hypotension, unresponsive to fluids or blood resuscitation, artery transection or occlusion and compartment syndrome [7].

whatever the type of treatment chosen, endovascular or conventional surgical repair, treatment cannot be postponed, causing a great impact on mortality [9].