Peripherally inserted central catheters (PICC) are useful access devices that allow for longer-term intravenous access. This allows patients requiring an extended period of intravenous medication to have this administered without the need for repeat vascular punctures. Even minimally invasive procedures such as line insertion come with risks. Of particular interest to this article is a limb threatening complication soon after line placement. We discuss the PICC line catheter tip as the likely cause for arrhythmia that lead to an embolic occlusion of an upper limb and required acute surgical intervention for limb salvage. We stress the rapid sequence of events that lead to this ultimate complication. We also stress the importance for all clinicians to be aware of these risks and take a cautious approach as the majority of patients requiring longer-term access are already at greater risks of thromboembolic disease due to their comorbidities.
There are but a handful of reported brachial artery aneurysms, the majority of which are pseudoaneurysms or false aneurysms caused by trauma or fistula creation. True or primary brachial artery aneurysms are even more rare, and if they occur, they often do so in isolation. In this case report, we discuss the interesting finding of a large primary brachial aneurysm together with an adjacent aneurysmal basilic vein identified intra-operatively. This presentation was 21 years after the renal transplant and ligation of an arteriovenous fistula in that same arm. It is noteworthy that the fistula was in the forearm and far away from the site of the untouched brachial area.
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