Treatment of an infected giant brachial artery pseudoaneurysm: a case report

Abstract

Periferik arter anevrizmaları, üst ekstremitelerde alt ekstremitelerden çok daha az görülür. Hemodiyaliz için yapı-lan venöz kateterizasyon esnasında istenmeden meydana gelen brakiyal arter delinmesine sekonder dev brakiyal arter psödoanevrizma oluşumu nadirdir. Bu psödoanev-rizmalar; yaşamı tehdit eden kanama, ekstremite fonksiyonlarında ciddi azalma, kol ya da parmakların kaybı ve hatta ölüm gibi ciddi komplikasyonlara neden olabilir. Bu yazıda, hemodiyaliz için yapılan kateterizasyon esnasında brakiyal arter delinmesine sekonder ortaya çıkan enfekte brakiyal arter psödoanevrizmasının, anevrizmektomi ve safen ven grefti interpozisyonu ile başarılı bir şekilde tedavisi sunulmuştur.Anah tar söz cük ler: Brakiyal arter; enfekte psödoanevrizma; safen greft; üst ekstremite.Peripheral artery aneurysms are much less frequent in the upper extremities than in the lower extremities. Giant brachial artery pseudoaneurysms secondary to inadvertent puncture of the brachial artery during venous cannulation for hemodialysis are rare. These pseudoaneurysms may result in serious complications such as life-threatening hemorrhage and severe decreases in extremity function and also lead to loss of arms or fingers and even death. In this article, we present a case of infected giant brachial artery pseudoaneurysm secondary to brachial artery puncture for hemodialysis and successfully treated with aneurysmectomy and a short saphenous vein interposition graft.

Management of Brachial Artery Pseudoaneurysms in Intravenous Drug Abusers

“…Although various treatment methodologies have been evaluated, no consensus could be built to standardize a treatment protocol. Major treatment plans of brachial artery pseudoaneurysm include ultrasound-guided compression, percutaneous thrombin administration, endovascular stenting, revascularization (primary or secondary), or simple ligation and excision 16,17 . We have chosen the last treatment scheme and all patients underwent a similar protocol of excision and ligation followed by debridement if required.…”

Management of Brachial Artery Pseudoaneurysms in Intravenous Drug Abusers

“…Various interventions for the management of pseudo-aneurysm have been documented in the literature with no clear consensus of prioritizing the management. Treatment options for the brachial artery pseudoaneurysm are simple ligation and excision, primary or secondary revascularization, endovascular stenting, percutaneous thrombin injection, and ultrasound-guided compression [ 9 , 18 ]. In this study, all patients presented late in the emergency department with bleeding from ruptured pseudo-aneurysm or oozing from pulsatile mass, and underwent simple ligation and excision pseudo-aneurysm (with debridement of surrounding tissue if infected) without primary revascularization.…”

“…The femoral artery pseudo-aneurysm is the most common vascular complication of IVDA; however, the brachial artery's involvement is not uncommon [9]. Brachial artery pseudo-aneurysm presented commonly 1 1 1 1 1 1 as an expanding, pulsatile, infected, painful mass, with/ without peripheral neurovascular compromise, especially in dermatomes of the median nerve [6].…”

“…Brachial artery pseudo-aneurysm presented commonly as an expanding, pulsatile, infected, painful mass, with/ without peripheral neurovascular compromise, especially in dermatomes of the median nerve [ 6 ]. The traditional treatment option for this complex problem is ligation and excision of pseudo-aneurysm and debridement of surrounding tissue if infected [ 9 ]. This surgical treatment has more favourable outcomes than those performed elsewhere due to good collaterals eliminating the need for reconstruction[ 10 ].…”