Compartment syndrome as a late presentation of brachial artery pseudoaneurysm following shaft of humerus fracture

Abstract

Peripheral artery pseudoaneurysm is rare in upper extremities compared with lower extremities. Early diagnosis and prompt management are two cornerstones of successful outcomes in these cases. Delay can lead to limb and life-threatening complications. We present a case of compartment syndrome of upper limb as a sequel to pseudoaneurysm of brachial artery for which we had to do shoulder disarticulation. The patient recovered uneventfully.

Acute compartment syndrome of the thigh complicated with a pseudoaneurysm of the arteria profunda femoris

“…However, there is still much debate about the threshold where the diagnosis can be made and fasciotomy should be performed 1,5,11 . In general, it is assumed a pressure measurement of >30 mmHg is diagnostic and requires urgent surgical fasciotomy to prevent tissue necrosis [1][2][3]11,12 . Another threshold commonly used is a perfusion pressure (diastolic pressure -intracompartmental pressure) of <20-30 mmHg 5 .…”

“…It most commonly occurs after trauma or endovascular procedures. Other causes are surgeries, infection, arteritis, IV drug abuse, and congenital defects of arteries 1, [12][13][14] .…”

“…When the pseudoaneurysm interferes with a neighboring nerve, it can also lead to paresthesia. Superficially located pseudoaneurysms can be detected on clinical examination by a pulsatile mass and audible souffle 1,12,14,17 .…”

“…If suspected, the diagnosis can be confirmed by a duplex ultrasound, CT angiography, an MRI or angiography 12,16,[18][19][20] . However, duplex ultrasound is the diagnostic test of choice 12,14,15 and will show a high velocity jet through a defect in the arterial wall 14 .…”

Acute Upper Limb Ischemia Due to Delayed Presentation of a Brachial Artery Pseudoaneurysm Post-Venipuncture

“…14 The most common course of management is open surgical repair, which yields best long-term results. 2,15 It is especially useful for large, rapidly expanding BAPs causing symptoms or complications, as it allows for rapid evacuation of the hematoma for relief of decompressive symptoms. Open surgical repair involves extensive exposure proximally and distally of the pseudoaneurysm to obtain adequate inflow and outflow control.…”