Rupture of a pseudoaneurysm in brachial artery after hemodialysis therapy: rare but serious complication

Year 2022, Volume: 4 Issue: 1, 123 - 125, 24.01.2022

Çağla Canbay Sarılar , Tolga Zeydanlı , Mert Sarılar , Ömer Ali Sayın

https://doi.org/10.38053/acmj.1051558

Abstract

Pseudoaneurysm (PSA) is a common complication that may occur on the AV fistula line. However, the 5 development of the PSA on a wrong cannulated brachial artery is a rarely seen and catastrophic 6 complication as occured in this case. Rupture is one of the serious complication of PSA. In our case 64 years old male with left snuff-box arteriovenous fistula (AVF) refer to emergency service with pain, swelling, tension on left arm after hemodialysis session. Doppler ultrasound confirmed brachial artery ruptured PSA active bleeding in to the approximately 4 cm diameter hematoma. The patient was transferred to the operating room and underwent to surgery for ruptured PSA repair. Four weeks after surgery, the arteriovenous fistula was used as an access for hemodialysis. Left hand 1st and 2nd digits distal phalanx flexion was limited Clinical suspicion, physical examination, and Doppler ultrasound are essential for early diagnosis and for optimal treatment. Doppler ultrasound can detect the lesion accurately. In patients with arteriovenous fistula during hemodialysis it should be considered pseudoaneurysm, rupture and neuropathy may occur. These are rare but serious complications so suspicion, clinical examination and doppler ultrasound are very important for early diagnosis and treatment.

Keywords

Hemodialysis, brachial artery pseudoaneurysm, pseudoaneurysm rupture

References

• Esteban MP, Otálora SB, Landeras RM, et al. Posttraumatic pseudoaneurysm of the brachial artery and postsurgical retraction of median nerve: description of a case and ultrasonography findings. Emerg Radiol 2007; 13: 269-72.
• Lee JY, Kim H, Kwon H, Jung S-N. Delayed rupture of a pseudoaneurysm in the brachial artery of a burn reconstruction patient. World J Emerg Surg 2013; 8.
• Cına G, Rosa MG, Viola G, Tazza L. Arteriel injuries following diagnostic,therapeutic and accidental arterial cannulation in hemodialysis patients. Nephrol Dial Transplant 1997; 12: 1448-52.
• Wielenberg A, Borge MA, Demos TC, Lomasney L, Marra G. Traumatic pseudoaneurysm of the brachial artery. Orthopedics 2000; 23: 1250-1322–4.
• Nugud OO, Hedges AR. Axillary artery pseudoaneurysm. Int J ClinPract2001; 55: 494–9.
• Kemp K, Radwan R, Shingler G, Davies C. Brachial artery pseudoaneurysm. BMJ Case Rep 2014; pii: bcr2014203924.
• Lapus TP, Trerotola SO, Savader SJ. Radial artery pseudoaneurysm complicating a brecia-cimino dialysis fistula. Nephron 1996; 72: 673-5.
• Habermann ET, Cabot WD: Median nerve compression secondary to false aneurysm of the brachial artery. Bull Hosp Joint Dis 1974; 35: 158-61.
• Ho PK, Weiland AJ, McClinton MA, Wilgis EF: Aneurysms of the upper extremity. J Hand Surg 1987;12: 39–46.
• Pelaz Esteban M, Beltran de Otalora S, Landeras RM, Gallardo E, Fernandez Echevarria MA, Perez Aguilar D. Posttraumatic pseudoaneurysm of the brachial artery and postsurgical retraction of median nerve: description of a case and ultrasonography findings. Emerg Radiol 2007; 13: 269–72
• Yetkin U, Gurbuz A. Post-traumatic pseudoaneurysm of the brachial artery and its surgical treatment. Texas Heart Institute journal/from the Texas Heart Institute of St Luke’s Episcopal Hospital, Texas Children’s Hospital 2003, 30: 293–7.
• Demırcin M, Peker O, Tok M, Özen H. False aneurysm of the brachial artery in an infant following attemtedvenipuncture.Turkish J Pediatr 1996; 38: 389-91.
• Popovsky MA, McCarty S, Hawkins RE. Pseudoaneurysm of the brachial artery: a rare complication of blood donation.Transfusion 1994;34: 253-4.
• Kehoe ME. US-guided compression repair of a pseudoaneurysm in the brachial artery. Radiology 1992; 182: 896.
• Morgan R, Belli AM: Current treatment methods for postcatheterization pseudoaneurysms. J Vasc Intervent Radiol JVIR 2003; 14: 697-710.
• Siu WT, Yau KK, Cheung HY, et al. Management of brachial artery pseudoaneurysms secondary to drug abuse. Ann Vasc Surg 2005, 19: 657-61.
• Pages ON, Alicchio F, Keren B, et al. Management of brachial artery aneurisms in infants. Pediatr SurgInt 2008; 24: 509–13.