True Brachial Artery Aneurysm in Patients with Previous Arterio-Venous Fistula Ligation and Immunosuppressant Therapy for Renal Transplantation: Case Report and Literature Review.

Sorin Barac,Andreea Luciana Rata,Alexandra Ioana Popescu,Sorin Dan Chiriac,Roxana Ramona Onofrei

doi:10.3390/healthcare10030470

Sorin Barac, Andreea Luciana Rata + Show 3 more

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https://doi.org/10.3390/healthcare10030470

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Abstract

Background/Objective: Brachial artery aneurysm (BAA) is a serious complication in patients with previous arterio-venous fistula (AVF), renal transplantation (RT), and immunosuppressive regimens. Until now, there has been no standard of care for these patients, especially for patients undergoing chronic dialysis and immunosuppressive treatment. The aim of this study was to investigate data from the literature regarding these patients and to suggest recommendations for the best approach to their treatment. Methods: A review of the literature was performed by searching the PubMed database in the English language. The review was accompanied by two case reports. A total of 24 articles with different variables—demographics, renal transplantation, aneurysm size, and type of surgery—were subjected to the review. In addition, two cases are reported. Conclusion: This review suggests that the best treatment for these patients is open surgery, with aneurysmectomy and graft interposition. Results: All patients had RT. The age of patients ranged from 26–77 yo, with a male predominance. The majority had an AVF ligated after RT. The main clinical symptoms were pain, swelling, and pulsatile mass (66%). All patients, except one, were treated through open surgery. The first option for treatment was reversed saphenous vein graft interposition (36%), followed by ePTFE graft (16%).

Highlights

Brachial artery aneurysm (BAA) in patients with previously ligated arterio-venous fistula (AVF) for hemodialysis and renal transplantation (RT) is rare and few cases are presented in the literature [2]
We present a literature review and two case reports of BAA, with the aim of evaluating the treatment modalities used for these patients
The terms used for the search were brachial artery aneurysm, AVF ligation, and RT

Summary

Introduction

Upper-extremity peripheral aneurysms are rare and account for less than 1% of all peripheral artery aneurysms. The brachial artery is involved around 0.5% of cases, with. Brachial artery aneurysm (BAA) in patients with previously ligated arterio-venous fistula (AVF) for hemodialysis and renal transplantation (RT) is rare and few cases are presented in the literature [2]. The number of patients that require RT is increasing worldwide.

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