Giant true Brachial Artery Aneurysm after Hemodialysis Fistula Closure in a Renal Transplant Patient

Abstract

The usual manifestation of brachial artery aneurysms is the incidental finding of a swelling of the arm, combined with paresthesia or pain in some cases. The etiology is often traumatic or secondary to drug abuse. Pathophysiology of brachial artery dilation in these cases is not completely clear. We herein describe a case of a 61-year-old male presenting with a giant, painful, pulsatile mass on his left arm. He was submitted to a cadaveric kidney transplant in 2005. He had a functioning arteriovenous fistula (AVF) on his right arm, and a spontaneously thrombosed radiocephalic AVF on his left arm. The aneurysm was surgically resected, sparing the median nerve that was totally entrapped and an inverted segment of the basilic vein interposed. At the follow-up, the patient did not present neurological or ischemic disturbs, and the vein graft maintained its patency.

Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature review

“…The third complication is aneurysmal arterial dilation proximal to AVF even post closure. Although brachial artery aneurysm is what has been reported [31,32], the possibility of it occurring in different arteries is plausible [33]. Vigilant follow-up for new mass or swelling at site of AVF with the aid of duplex scan is the best option for early detection and treatment.…”

A case of aneurysmal dilation of a brachial artery after venous outflow resection

“…True aneurysmal degeneration of the brachial artery is a relatively rare condition, with a reported incidence in the literature of <1% 1 . The pathophysiologic mechanism of brachial artery aneurysms involves local hemodynamic factors such as increased flow that lead to endothelial production of nitric oxide and reactive oxygen species; this results in upregulation of matrix metalloproteinase production and damage to the arterial wall 2, 3. Shear stress leads to a weakened wall and aneurysmal degeneration 4, 5.…”

“…Shear stress leads to a weakened wall and aneurysmal degeneration 4, 5. Aneurysm development can occur in both active fistulas and those that have been ligated, with an average time of 10 to 20 years from creation to aneurysmal dilation 2, 6, 7, 8. Patients who have received a kidney transplant constitute a group at particularly increased risk, with reports of immunosuppression potentially contributing to more rapid aneurysm development and rupture 2, 9, 10, 11, 12…”

True brachial artery aneurysm after arteriovenous fistula closure following renal transplantation: a case report and literature review

“…The main etiologies of true BAAs are blunt trauma, atherosclerosis, infection, and vasculitis, and more than 50% of all patients with true BAAs have a history of blunt trauma [2]. A recently reported rare cause of true BAAs is arteriovenous fistula (AVF) closure after hemodialysis or renal transplantation [4, 5]. High flow due to AVF and essential drugs after transplantation, steroids, and immunosuppressants can also cause BAAs [4, 5].…”

“…A recently reported rare cause of true BAAs is arteriovenous fistula (AVF) closure after hemodialysis or renal transplantation [4, 5]. High flow due to AVF and essential drugs after transplantation, steroids, and immunosuppressants can also cause BAAs [4, 5]. The standard treatment for BAAs remains controversial because of their rarity and thus lack of detailed information.…”