Pseudoaneurysm of brachial artery: A rare cause of median nerve compression

Abstract

BackgroundThe authors present an unusual clinical case of high median nerve compression caused by an iatrogenic pseudoaneurysm of the brachial artery after an angiography with a follow up of 9 months.MethodsA 73-year-old male was seen with progressive numbness, loss of opponency and diminution of strength of finger flexion in the left hand after an angiography with direct puncture of the left humeral artery. Physical examination revealed a hard consistency internal distal arm swelling with the size of a walnut, non-pulsatile and with a Tinel sign on percussion. Upper extremity arterial Doppler ultrasonography and magnetic resonance imaging didn't point to a pseudoaneurysm. Given the persistence and progressive worsening of symptoms, the patient was operated at 4 months after the beginning of symptoms through an anterior approach of the left elbow. The tumefaction corresponded to a brachial artery pseudoaneurysm completely thrombosed causing severe compression of the median nerve. Microsurgical neurolysis of the median nerve was performed and the pseudoaneurysm was removed.ResultsAt 9 months of follow-up the patient had total recovery of flexion of the thumb and forefinger and recovery of opposition with slight hypoesthesia on the volar surface of the radial fingers of the hand.ConclusionsThis case represents a rare form of high median nerve compression after angiography. The increased use of endovascular procedures may cause a higher frequency of these neurological injuries, and if confirmed, the patient should be operated as soon as possible to avoid serious neurological sequelae.

Pseudoaneurisma traumático em artéria braquial após retirada de implante contraceptivo subdérmico

“…1 It is most often seen in injecting drug users and hemodialysis patients. 1,2 In this paper, we describe an uncommon case of iatrogenic brachial pseudoaneurysm caused when attempting to remove an SCI. These complications can progress to conditions such as hemorrhagic rupture, compression of nerves and veins, formation of significant edema that restricts distal perfusion, and localized necrosis of the skin because of ischemia.…”

“…These complications can progress to conditions such as hemorrhagic rupture, compression of nerves and veins, formation of significant edema that restricts distal perfusion, and localized necrosis of the skin because of ischemia. 1,2,4,5 Pseudoaneurysms measuring 2 cm or less tend to be asymptomatic. The majority of symptomatic cases present with pulsating masses.…”

“…Other factors include advanced age, female sex, and elevated body mass index (BMI). 2,4,5 Implanting or explanting subdermal contraceptive devices can increase the frequency of vascular and neurological injuries. 3 Insertion and later removal of these implants is within the expertise expected of a specialist.…”

“…Pseudoaneurysms are an increasingly common complication, because of the significant increase in invasive, diagnostic, and therapeutic procedures. 1,2 Brachial artery pseudoaneurysm is a rare condition that occurs in fewer than 0.04% of cases. 1 The most common etiology is iatrogenic (puncture or diagnostic tests and examinations).…”

“…It occurs in 0.3 to 0.7% of patients and causes increased morbidity and mortality, longer hospital stays, and higher healthcare expenditure. 1,2 The frequency of subdermal contraceptive implant (SCI) use for contraception and hormone replacement has been increasing over the last 5 years and is associated with a total complication rate of around 3%. 3 Here, the authors present an uncommon clinical case of a brachial pseudoaneurysm caused by attempted removal of an SCI and complicated by compression of the median nerve.…”