Brachial artery pseudoaneurysm arising from the stump of a ligated arteriovenous fistula

Abstract

An 85-year-old man presented to A&E department with a bleeding, pulsatile mass within the left antecubital fossa. He reported a 3-month history of an increasing, painless swelling. He had a history of end-stage renal failure secondary to antiglomerular basement membrane disease. 14 years prior, he had a left brachiocephalic fistula created, which was ligated shortly after its creation due to Steal syndrome. Examination revealed a 10×15×10 cm pulsatile, non-tender mass with overlying ulceration in the left antecubital fossa. Arterial duplex demonstrated a pseudoaneurysm arising from the left distal brachial artery with a 9 mm neck. The patient underwent surgical exploration and repair. At surgery, a large brachial artery pseudoaneurysm at the site of the previous fistula ligation was found. The overlying ulcerated skin and pseudoaneurysm were excised en mass, and the arterial defect repaired by transection and end-to-end anastomosis. This is the first reported case of a brachial artery pseudoaneurysm occurring following arteriovenous fistula ligation.

Aneurısmas arterıales de extremıdad superıor: etıología, manejo y resultado

“…Uncontrolled hypertension, anticoagulations, and inadequate compression after arterial blood drawing may play important role of its formation. Pseudoaneurysms occur in a shorter period and have a higher risk of rupture, and most of them can be preventable according to the nature of its formation 7,8 . The incidence found in our series is around 65%.…”

Radial Artery Aneurysm Arising from the Stump of a Ligated Arteriovenous Fistula in a Kidney Transplant Patient

“…In most published cases, brachial artery aneurysm has been widely managed by surgical intervention by aneurysmectomy and arterial reconstruction using a synthetic or autologous venous graft. 1 , 2 , 3 , 4 Studies suggest that repair with autologous vein graft, such as the GSV interposition or brachial vein interposition, provides superior patency compared to the PTFE bypass and composite grafting. 5 Interestingly, the management of this type of aneurysms with endovascular intervention has not yet been reported in any of the reported cases.…”

“…The ligation of the AV fistula is recommended after transplantation to avoid local complications, such as hemorrhage, aneurysm, pseudoaneurysm, infection, thrombosis, and neuropathy, and systematic complications, such as steal syndrome, cardiac failure, and pulmonary hypertension. 1 While aneurysm and pseudoaneurysm are common complications to AV fistula, the development of aneurysm from the stump of a ligated AV fistula is a rare entity. Several case reports have been published describing this entity in the brachial artery.…”

“…Several case reports have been published describing this entity in the brachial artery. 1 , 2 , 3 , 4 , 5 …”