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.
Highlights
Pseudoaneurysms or false aneurysms are pulsatil masses which is encircled by a fibrous capsule and which has anomalous connection between a ruptured vessel and the soft tissue [1]
We report a case of a patient with ruptured PSA of the brachial artery due to unsuccessful venous cannulation after a hemodialysis session
Many imaging modalities can be used as arterial Doppler sltrasonography, conventional angiography, computed tomography (CT) angiography and magnetic resonance imaging (MRI)
Summary
Pseudoaneurysms or false aneurysms are pulsatil masses which is encircled by a fibrous capsule and which has anomalous connection between a ruptured vessel and the soft tissue [1]. We report a case of a patient with ruptured PSA of the brachial artery due to unsuccessful venous cannulation after a hemodialysis session. A 64-year-old male patient was admitted to the emergency department with pain, swelling, and tension on left arm. His medical history was hypertension, coronary bypass surgery 4 years ago, and snuffbox AVF in the left arm had been under hemodialysis for 4 years. The patient had tension, pain in the left arm. Doppler ultrasound confirmed active bleeding approximately 4 cm diameter hematoma which was originated from the brachial artery in left arm. Patient had an uneventful recovery and he discharged postoperative 5th day without any deficit in the left arm.
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