Complex Regional Pain Syndrome Type II Secondary to Endovascular Aneurysm Repair

Abstract

Complex regional pain syndrome (CRPS) is a chronic pain disorder characterized by severe pain and vasomotor and pseudomotor changes. Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms is a recent advance in vascular surgery that has allowed repair of AAA while offering reduced intensive care unit and hospital lengths of stay, reduced blood loss, fewer major complications, and more rapid recovery. Pseudoaneurysms are a rare complication of an EVAR procedure that may result in a wide range of complications. The present report examines CRPS type II as a novel consequence of pseudoaneurysm formation from brachial artery access in the EVAR procedure. To our knowledge, this is the first reported case of CRPS type II presentation as sequelae of an EVAR procedure.

Successful Treatment of Complex Regional Pain Syndrome with Pseudoaneurysm Excision and Median Nerve Neurolysis

“…31 Pseudoaneurysm associated CPRS is exceedingly rare and, to date, only one case has been reported following transbrachial catheterization. 5 In that reported case, the patient developed symptoms of CRPS type II approximately four months following repair of the pseudoaneurysm. The patient failed subsequent management with pharmacologic and occupational therapy as well as stellate ganglion blocks and ultimately died before any additional treatment modalities could be initiated.…”

“…1,3 Complex regional pain syndrome is a rarely cited complication of trans-arterial catheterization. [3][4][5][6] Here; we present a unique case of post-catheterization CRPS resulting as a consequence of pseudoaneurysm formation. Treatment methods used in previously reported cases include pharmacologic therapy, ganglion blockade and spinal cord stimulation with varied outcomes.…”

“…3 Vascular inciting events are rare and have been reported following arteriovenous fistula and grafting procedures as well as transartertial catheterization using transbrachial, transradial and transfemoral approaches. 3,5,6,21,22 Other reported etiologies for catheterinduced CRPS include radial artery trauma and median nerve ischemia due to prolonged wrist compression for hemostasis. 6,23 Development of a pseudoaneurysm is a relatively common complication following percutaneous access for catheterization procedures, occurring in up to 5% of patients.…”

“…26 26,27 Neuropathic symptoms are infrequently reported as a complication of pseudoaneurysm formation and have been described following transradial, transbrachial and transfemoral access. [3][4][5]28,29 Due to the proximity of the brachial artery to the median nerve, motor and sensory loss along the median nerve distribution has been cited to develop as a consequence of brachial pseudoaneurysm formation. [28][29][30][31][32] In cases of high median nerve compression, the characteristic 'benediction hand' sign has also been reported.…”

“…The patient failed subsequent management with pharmacologic and occupational therapy as well as stellate ganglion blocks and ultimately died before any additional treatment modalities could be initiated. 5 …”