Brachial Artery Aneurysm Research Articles

102. Surgical Treatment of Brachial Artery Aneurysm Associated qith Arteriovenous Shunt for Hemodialysis: Case Report

Introduction: A brachial artery aneurysm is a rare complication of an arteriovenous fistula (AVF) created for hemodialysis access. This report details the case of a patient with a brachial artery aneurysm associated with an AVF for hemodialysis, who underwent successful surgical treatment. Case: A 64-year-old female with CKD undergoing regular hemodialysis presented with a painful lump in her right arm one-week AVF installation. Her medical history included a left nephrectomy in 2022, previous failed AV fistula placement, and central dialysis line (CDL) insertion. The patient had a medical history significant for CKD requiring routine HD twice a week. Local examination of the patient's right arm revealed a mobile, painful lump, diagnosed as a brachial artery aneurysm, limiting arm movement. A chest X-ray showed cardiomegaly, thoracic spondylosis, and proper CDL positioning. Laboratory results were normal. The patient underwent surgical repair of the aneurysm and was hospitalized for three days postoperatively. Post-surgery treatment included analgesics, antibiotics, anticoagulation therapy, and outpatient clopidogrel. Conclusions: A brachial artery aneurysm is a rare complication of an AVF, posing risks of peripheral embolism and hand ischemia, and therefore requires surgical correction.

Axillary and brachial artery aneurysm associated with a longstanding arteriovenous fistula

Upper extremity true arterial aneurysms are rare and often present as a pulsatile mass with associated pain and paresthesia from peripheral nerve compression, and can lead to acute limb ischemia from thromboembolic sequela. History of arteriovenous dialysis access and immunosuppression after renal transplantation may contribute to the development of true aneurysms.This report describes the management of a patient with end-stage renal disease (ESRD) with multiple left upper extremity dialysis access who presented with an axillary and brachial artery aneurysm.

Giant Brachial Artery Aneurysm

Giant Brachial Artery Aneurysm

Severe lupus after two years of hemodialysis: It exists and can be serious

Progression of lupus nephropathy (LN) to end-stage renal disease is a serious complication and requires subsequent replacement therapy. Lupus disease activity is extinguished in chronic hemodialysis. We report the observation of a 35-year-old female patient, in conventionnel hemodialysis for two years (chronic glomerulonephritis), admitted to the emergency room for convulsions, left flaccid tenderness, cutaneous-mucosal pallor and altered general condition evolving since three days before her admission. we also observed a spontaneous ecchymotic lesions on the right arm. Echodoppler of the right upper extremity was in favor of a partially thrombosed aneurysm of the right brachial artery. The biological workup showed pancytopenia, the requested immunological workup showed a low complement C3, a positive level of anti-DNA antibodies. The patient was treated as severe lupus flare: Bolus of methylprednisolone, followed by oral administration, associated with Mycophenolate mofétil (MMF) at a dose of 1 g/d. The evolution was favorable on the clinical, biological and radiological levels.Systemic lupus erythematous (SLE) can occur even after several years of hemodialysis and sometimes in a severe form, pushing the clinician to think of this pathology in the presence of evocative signs.

Early and Midterm Outcomes of Endovascular Treatment in Arterial Manifestations of Vascular Behcet Disease

Behcet's disease (BD), originally described by Hulusi Behcet in 1937, is a chronic relapsing inflammatory process of an immunologic syndrome and the involvement of the vascular system is called Vasculo-Behcet Disease. This is a retrospective study evaluating 21 patients diagnosed with Vascular-Behcet's disease who underwent endovascular treatment. This single-center study was conducted between January 2016 and January 2022. Early and mid-term endovascular outcomes of a total of 21 patients (16 males, 5 females with a median age of 42 years; range, 31 to 46 years), with a diagnosis of VBD, who underwent endovascular arterial repair in our hospital, were retrospectively analyzed. Follow-ups were scheduled for the first and sixth postoperative months and every 6 months thereafter. For symptomatic patients, imaging studies and additional interventions were planned. The primary outcomes were a procedural success and the requirement for re-intervention. Secondary outcomes were complications and all-cause of mortality. Twenty-one patients underwent endovascular repair. In this study, one balloon-expandable stent for brachial artery aneurysm (4,8%), 1 Viabahn graft for femoral artery aneurysm (4,8%), 2 tube endograft for ruptured iliac artery aneurysm (9,5%), 1 tube endograft (TEVAR) insertion at the aortic bifurcation for infrarenal abdominal aortic occlusion (4,8%), one Chimney-TEVAR for saccular arcus TAA (4,8%) and 7 TEVAR for saccular TAA (33,3%), 1 EVAR for an intact and symptomatic infrarenal AAA (4,8%), 1 EVAR (aorto-uniiliac) for ruptured iliac artery aneurysm (4,8%), 6 EVAR for ruptured abdominal aortic aneurysm (28,5%) were deployed. The technical success rate was 100% with a mean follow-up period of 50,4±10,7 months (8 - 66 months). The mean aneurysm diameter was 10,7±53mm. In the follow-up period, three patients presented with a hematoma at the insertion site of the sheath (14,3%). There were no early mortalities. Three patients required re-intervention (14,3%); one of these underwent open surgical repair due to a pseudoaneurysm of the access site (4,8%). The Kaplan-Meier analysis revealed freedom from reintervention rate as 94,1±5,7% at one year, 85,6±9,7% at three years, and 68,4±17,1% at five years. Awareness of the BD especially for vascular involvements in young ages is lifesaving. Endovascular therapy with proper medical treatment seems to be the treatment of choice according to the early and midterm successful results with low morbidity and mortality.

A Brachial Artery Pseudoaneurysm Treated with a Bifurcated Y-Shaped Artificial Vessel Graft.

Brachial artery aneurysms are rare diseases that may be caused by infection or trauma. We report a case of a 71-year-old man who presented with a mass in his right antecubital fossa that increased in size slowly over time. Three years ago, the patient underwent ascending and total-arch replacement with artificial vessel graft to treat aortic root and ascending aorta aneurysm. Preoperative physical examination of right upper extremity showed a nonpulsatile mass with normal pulse of axillary, brachial, and radial arteries. The mass was removed and brachial artery reconstruction was done initially using saphenous vein graft. Two months later, the patient revisited with recurrent pseudoaneurysm, involving the bifurcation point of brachial artery. Aneurysm was totally resected and the brachial artery was reconstructed by interposition graft using a bifurcated GORE-TEX artificial vessel graft. The patient healed without complication and no recurrence was observed. Artificial vessel graft is an available option for reconstruction, and revascularization of vessel defect after excision of brachial artery aneurysm may involve bifurcation point.

Successful Reconstruction of a Ruptured Brachial Artery Aneurysm With Superficial Femoral Vein

A 50 year old male on chronic haemodialysis through a brachiocephalic arteriovenous fistula was transferred because of pain and symptoms of median nerve compression (A and B, asterisk). Duplex scanning noted a ruptured brachial artery (A, arrow) with a maximum diameter of 30 mm. After achieving haemostatic control the median nerve was separated from the aneurysmal wall and the aneurysm was resected. (B) A 4–5 cm length of reversed superficial femoral vein (arrow) was used for brachial artery reconstruction to prevent infection. The great saphenous vein was not used because of diameter mismatch with the dilated brachial artery.Image 1

A rare case of median nerve intraneural hematoma after stenting of right iliac artery

Aim: Brachial artery access is an alternative approach to endovascular interventions when access to the femoral, radial, or ulnar arteries is not feasible, but it carries higher risk of periprocedural complications than other approaches, including median nerve injury. Nerve injuries can occur by direct puncture or by compression, with hematoma being the most common cause. Sometimes the compartment syndrome can accompany the direct nerve injury, masking the signs of a nerve dysfunction. Case report: We present a patient with a false aneurysm of brachial artery, surrounding soft tissue hematoma with volar arm and forearm compartment syndrome and a simultaneous median nerve intraneural hematoma caused by a direct punction. The combination of injuries occurred after brachial artery access for endovascular treatment of bilateral iliac artery steno-occlusive disease. The patient was successfully treated by fasciotomy, arterial sutures, and nerve decompression via paraneuriotomy. Conclusions: Intraneural hematoma caused by direct puncture can be masked by concomitant compartment syndrome. Emphasis should be put on prevention, early recognition, and timely surgical treatment of intraneural hematomas, especially those accompanied by fascial compartment syndrome after endovascular interventions.

Anévrisme de l’artère brachiale chez un patient transplanté rénal après fermeture de fistule distale

Brachial artery aneurysmal degeneration is an exceptional complication of distal native fistulas. Chronic mechanical stresses due to high flow, as well as immunosuppressants drugs following renal transplantation, are the mains factors implicated in the pathophysiological mechanism. We report a case of a transplant patient with a true, symptomatic, brachial artery aneurysm, 8 years after transplantation and 5 years after radiocephalic wrist fistula ligation. The patient underwent open surgical repair, with aneurysm resection and end-to-end anastomosis. We present a literature review of the different therapeutic strategies of this unusual entity.

A Large True Brachial Artery Aneurysm in an Infant.

A 6-month-old male was admitted to the children's hospital for management of an underlying gastrointestinal illness. During his admission, a large, pulsatile mass was incidentally noted in the left upper arm concerning for an expanding pseudoaneurysm. Vascular surgery was consulted, and further workup with a CT angiogram demonstrated a brachial artery aneurysm 3cm in greatest diameter. The patient was taken to the operating room, where lateral aneurysmorraphy was performed without complication. His neurovascular exam remained intact postoperatively. The presented case demonstrates a viable approach to the surgical management of this clinical challenge in infants. Although reports of brachial artery aneurysm in this age group are rare in the literature, resection with primary repair and interposition grafting have also been described. Long-term outcomes are not available in these cases. Lateral aneurysmorraphy allows for ongoing monitoring and future resection and bypass of the aneurysm as the patient continues to grow.

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

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%).

Brachial artery aneurysm as a late complication of arteriovenous fistula.

Brachial artery aneurysm (BAA) is a rare late complication of arteriovenous fistula (AVF). It brings the risk of peripheral embolism and hand ischemia and is defined by brachial artery diameter above 10 mm or by regional dilatation by >50%. BAA is described in the literature in closed radiocephalic arteriovenous fistulas after kidney transplantation. The aim of the study was to analyze the prevalence of BAA and of their more dangerous forms. A observational one center study performed on patients after kidney transplantation with AVF or arteriovenous graft (AVG). We invited all patients followed up for kidney transplantation in our center. Arterial diameter greater than 10 mm was considered as a brachial artery aneurysm to simplify the detection and evaluation of aneurysms. About 162 patients with AVF after kidney transplantation were examined between 4/2018 and 4/2020. Brachial artery aneurysm was detected in 34 patients (21%) with AVF or AVG, of them 7 had confirmed wall thrombi. AVF flow volume of more than 1500 ml/min increased the risk of BAA development by 4.54x. Eight aneurysms were treated surgically. After this surgery, the primary patency was 87.5% in 12 months. Brachial artery aneurysm was relatively frequent in our study compare to the literature. Aneurysm or dilatation of the brachial artery is more frequent in functional AVFs. Surgical correction is necessary in cases of complicated aneurysms to prevent distal embolization.

Reconstruction of brachial artery in posttraumatic false aneurysm

In the article were reflected important issues of ethiopathogenesis, diagnostics and treatment of false aneurysm of brachial artery. Literature view and personnel experience of authors are shown that main causes of developing false aneurysm of brachial artery are non-revealing vessels injuries due to diagnostic-treating mistakes. Despite of using modern methods of mini-invasive treatment of aneurysm treatment till now the open surgery is continued to be a gold standard. In the clinical case are shown all features of diagnostics and successful treatment of false aneurysm of brachial artery with good middle-remote results.

Isolated brachial artery aneurysm: a rare presentation of paediatric Behçet’s disease

Behçet's disease is a rare disease characterised by recurrent oral ulcers, with systemic manifestations including genital ulcers, ocular disease, skin lesions, gastrointestinal disease, neurologic disease, vascular disease and arthritis. Most clinical manifestations of Behçet's disease are believed to be due to vasculitis. The heterogeneous clinical spectrum is influenced by sex, ethnicity and country of residence. Vascular manifestation in the form of isolated large brachial artery aneurysm is rare in children. Treatment involves aneurysmorrhaphy to avoid rupture or ischaemic sequelae in addition to lifelong medical management to control vasculitis.

Masson Hemangioma in a Brachial Artery Aneurysm

Masson hemangioma is a rare benign vascular tumor characterized by intravascular papillary endothelial hyperplasia (IPEH). Numerous case reports have described lesions in the digits, neck, oral cavity, and intracranially. IPEH involving primary brachial artery aneurysm is extremely rare, with only a handful of reported cases. We present a 43-year-old female with a true distal brachial artery aneurysm who presented with a painful pulsatile mass in the antecubital region. She underwent aneurysm resection and end-to-end repair with a saphenous vein graft. Histology confirmed the diagnosis of IPEH with characteristic features of papillary hyperplasia within the intravascular thrombus.

Crutch-induced brachial artery aneurysm

Angiología es una revista científica bimensual editada desde 1949. Está dedicada al estudio de las enfermedades vasculares, incluyendo todos los aspectos de la medicina vascular, el diagnóstico no invasivo, el tratamiento quirúrgico tradicional arterial y venoso, así como el mínimamente invasivo y/o endovascular.

True Brachial Artery Aneurysm in Non-smoker Woman

Aneurism is a stretch, convexity and sacs in artery which is caused by abnormally congenital connective tissue, infection, arterial inflammation or artery wall trauma. True brachial artery aneurysm is relatively rare. There are only some cases that have been reported previously in medical literature. Brachial artery aneurysm might be asymptomatic or revealed by a brachial mass with beating pulse or peripheral ischemia. The diagnosis usually relies on ultrasound and arterial scan or magnetic resonance imaging (MRI). The main treatment is the surgery which allows cutting the aneurysm and grafted with a part of great saphenous vein by two end-to-end anastomoses. We present a case report of true aneurysm of brachial artery in a 40 years old woman who was treated in Thai Binh Medical University Hospital.

A Large Isolated True Brachial Artery Aneurysm in 6 Months Boy: Managed Surgically with Perfect Outcome. A Case Report

A Large Isolated True Brachial Artery Aneurysm in 6 Months Boy: Managed Surgically with Perfect Outcome. A Case Report

Successful management of a brachial artery aneurysm with percutaneous intervention and one-month rivaroxaban therapy.

Successful management of a brachial artery aneurysm with percutaneous intervention and one-month rivaroxaban therapy.

True brachial artery aneurysm after arteriovenous fistula closure following renal transplantation: a case report and literature review

BackgroundA brachial artery aneurysm (BAA) is a rare condition accounting for 5% of all peripheral arterial aneurysms. More cases of true BAAs after arteriovenous fistula (AVF) closure have been reported in the past two decades.Case presentationA 60-year-old man who underwent AVF closure after renal transplantation had a true BAA on his left elbow that had grown within the past 6 months. We successfully performed an open repair with end-to-end anastomosis. No complications occurred for 1 year.ConclusionsHigh flow due to AVF and some collateral factors such as the use of steroids and immunosuppressants after renal transplantation, arteriosclerosis, and chronic mechanical stimulation might contribute to BAA formation.