Brachial Artery Pseudoaneurysm Research Articles

Brachial artery pseudoaneurysm after phlebotomy for iron overload: first case report

Brachial artery pseudoaneurysm after phlebotomy for iron overload: first case report

US-Guided Percutaneous Thrombin Injection Of Upper Extremity Pseudoaneurysms

Objectives: While percutaneous thrombin injection for treatment of lower extremity pseudoaneurysms (PSA) is well documented, little has been published regarding this technique in the upper extremity. The purpose of this investigation was to evaluate the safety and effectiveness of ultrasonography-guided (US-guided) percutaneous thrombin injection for the treatment of upper extremity brachial and radial artery PSAs. Methods: Retrospective single institution study from January 2009 to December 2012. Demographics, PSA size, thrombin dose, therapy outcome, and complications were documented. Post treatment success was confirmed with Duplex US. Results: Between January 2009 and December 2012, 86 upper extremity arterial duplex ultrasounds were performed for a clinical suspicion of an upper extremity PSA. 18 ultrasounds (20.9%) demonstrated an iatrogenic upper extremity PSA. Mean age was 73.5 6 10.6 years and 67% (n 1⁄4 12) were female. Nine patients (50%) developed a PSA after removal of 6 French sheath, five (28%) after removal of a 5 French sheath, two (11%) following removal of a 4 French sheath, one after failed PICC line insertion and one following removal of a brachial arterial line. Fourteen upper extremity PSAs (77.8%) in 18 patients were treated with US-guided thrombin injection. Three of the 14 (21.4%) were radial artery PSAs and 11 (78.6%) were brachial artery PSAs. Thirteen of the 14 (92.9%) attempts at US-guided thrombin injection were successful with a single injection. The mean injected thrombin dose was 2079 IU (range 300-8000). There were no thrombotic or embolic complications at a mean follow-up of 19.4 months. Conclusions: US-guided thrombin injection is safe and effective for the treatment of iatrogenic brachial and radial artery PSAs.

Complex regional pain syndrome type II secondary to endovascular aneurysm repair: a case report

A 79-year-old male with an abdominal aortic aneurysm (AAA) status post endovascular aneurysm repair (EVAR) and left renal artery stent placement presented to our clinic with symptoms of atrophy and weakness of the left forearm and pain in the left hand. The EVAR procedure was performed two months prior. Upon examination, a pulsatile mass of 2-4cm was discovered in the left upper arm. Review of the operative report revealed that a catheter was introduced into the left brachial artery. An upper extremity ultrasound revealed a pseudoaneurysm of the left brachial artery.

Rupture of a Brachial Artery Caused by a Humeral Osteochondroma

Pseudoaneurysm resulting from vascular impingement by an osteochondroma is extremely rare. The authors report on the case of a 16-yearold male who had a brachial artery pseudoaneurysm and vessel rupture associated with a humeral osteochondroma. This case suggests that pseudoaneurysm should be considered for the differential diagnosis in patients with soft tissue masses and a cuspidal osteochondroma located near the neurovascular bundle and recommends Doppler sonography or angiography.

A Case of Nontraumatic Pseudoaneurysm of Brachial Artery

A Case of Nontraumatic Pseudoaneurysm of Brachial Artery

Ultrasound-guided compression repair of peripheral artery pseudoaneurysm: 8 years’ experience of a single institute

BackgroundFemoral artery pseudoaneurysm is a rare complication but with increasing frequency nowadays due to the advances of endovascular intervention. Rare cases of brachial orpopliteal artery pseudoaneurysms had ever been reported and the predictive factors of failed ultrasound-guided compression repair (UGCR) are controversial. MethodsDuring the past 8 years, 21 patients (12 males and nine females; median age, 64 years) with peripheral pseudoaneurysms (femoral artery, n = 17; brachial artery, n = 3; popliteal artery, n = 1) were enrolled. A high frequency of 10–12 MHz color ultrasound was used to evaluate the presence of a pseudoaneurysm. The area of the pseudoaneurysm sac and the width and length of the pseudoaneurysm neck were recorded. Under real-time ultrasound guiding, gradual pressure was applied with the probe to obliterate flow in the pseudoaneurysm neck while still allowing flow through the supplying artery for approximately 10–15 minutes with at most three times (45 minutes’ compression). Follow-up color sonography was obtained at 24 hours to detect any recurrence. ResultsThe mean area and the largest dimension of the 21 pseudoaneurysms were 7.3 ± 6.5 cm2 and 3.6 ± 1.8 cm, respectively. The mean width and the mean length of the pseudoaneurysm neck were 2.1 ± 0.9 and 3.3 ± 2.0 mm, respectively. Successful thrombosis of the pseudoaneurysm was achieved in 19(90.5%) patients. The mean compression time of the 19 successful UGCR was 21.2 ± 11.0 minutes. Two patients failed the UGCR procedure after a 45-minute compression. Both of the two pseudoaneurysms were located in the femoral artery with a large width of the pseudoaneurysm neck (4 and 5 mm, respectively). ConclusionUGCR is a safe and cost-effective therapy for treating peripheral pseudoaneurysms of not only femoral artery, but also brachial artery and popliteal artery. We considered the width of the pseudoaneurysm neck to be the predictive factor of technical success.

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

Periferik arter anevrizmalari, ust ekstremitelerde alt ekstremitelerden cok daha az gorulur. Hemodiyaliz icin yapilan venoz kateterizasyon esnasinda istenmeden meydana gelen brakiyal arter delinmesine sekonder dev brakiyal arter psodoanevrizma olusumu nadirdir. Bu psodoanevrizmalar; yasami tehdit eden kanama, ekstremite fonksiyonlarinda ciddi azalma, kol ya da parmaklarin kaybi ve hatta olum gibi ciddi komplikasyonlara neden olabilir. Bu yazida, hemodiyaliz icin yapilan kateterizasyon esnasinda brakiyal arter delinmesine sekonder ortaya cikan enfekte brakiyal arter psodoanevrizmasinin, anevrizmektomi ve safen ven grefti interpozisyonu ile basarili bir sekilde tedavisi sunulmustur. Anah tar soz cuk ler: Brakiyal arter; enfekte psodoanevrizma; safen greft; ust 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 Bilateral Brachial Artery Pseudoaneurysms in an Intravenous Drug User

Management of Bilateral Brachial Artery Pseudoaneurysms in an Intravenous Drug User

Use of Chimney Grafts in Aortic Arch Pathologies Involving the Supra-Aortic Branches

To present a clinical experience with the use of chimney grafts in the endovascular repair of aortic arch pathologies involving the supra-aortic branches. The chimney technique consists of endovascular stent or stent-graft placement parallel to the main aortic stent-graft in order to preserve or rescue flow to aortic branch vessels and to allow proximal extension of endograft fixation zones. Between April 2009 and January 2011, 9 patients (7 men; mean age 58 years, range 39-76) had chimney grafts installed to the left subclavian artery (LSA) or left common carotid artery (LCCA) during urgent thoracic endovascular aortic repair (TEVAR) of 5 aortic arch aneurysms, a mobile aortic thrombus with peripheral embolism, symptomatic type B dissection, penetrating aortic ulcer, and persistent type I endoleak after TEVAR. Eight chimney grafts were implanted into the LSA in 6 patients and 5 into the LCCA in the other 3 patients. The immediate technical success was 88.9%. The post-TEVAR type I endoleak persisted despite the chimney graft; the patient underwent surgical arch replacement. One patient died within 30 days due to cardiac insufficiency. There were 2 access site complications requiring surgery (brachial artery pseudoaneurysm and heavily calcified femoral artery puncture site). Over a median follow-up of 15 months (range 4-22), all chimney grafts remained patent in the 7 surviving and successfully treated patients. The use of chimney grafts in selected aortic arch pathologies with involvement of supra-aortic branches is safe and feasible. Long-term results and large series are needed in order to draw robust conclusions regarding this promising alternative endovascular technique.

Traumatic brachial artery pseudoaneurysm diagnosed in the emergency department with point-of-care bedside ultrasound

Abstract Case A 55-year-old gentleman was referred to the emergency department for penetrating trauma of his left upper arm. X-rays identified a metallic foreign body. Clinical examination revealed a swollen left upper arm with a pulsatile mass. Point-of-care bedside ultrasound in the ED confirmed a traumatic brachial artery pseudoaneurysm. Discussion The features of a peripheral pseudoaneurysm and its ultrasonographic appearance in both B-mode, and color Doppler imaging.

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

This study retrospectively evaluated ultrasonography-guided (US-guided) percutaneous thrombin injection for the treatment of postcatheterization femoral and brachial artery pseudoaneurysms. Fifty-five patients with postcatheterization femoral artery (n = 53) or brachial artery (n = 2) pseudoaneurysms were treated using US-guided human thrombin (500 IU/mL) injection. Pseudoaneurysm size, thrombin dose, therapy outcome, and complications were documented. Follow-up color Doppler US was performed 7 and 30 days after treatment. Short-duration supplemental compression was applied to six patients at the first week follow-up examination after a reinjection of thrombin had failed. Mean pseudoaneurysm volume was 20.3 ± 18.7 cm(3). The mean injected thrombin dose was 478 ± 238 IU. Thirty-eight (69.1%) of the 55 pseudoaneurysms were thrombosed with a single injection, and 11 of 17 pseudoaneurysms were thrombosed after a second injection. All (100%) of the 41 pseudoaneurysms that were diagnosed within the first two weeks of postcatheterization were successfully treated. The overall primary success rate was 89.1% (49 of 55 pseudoaneurysms). Supplemental compression promoted thrombosis in four of the six patients who had treatment failure with thrombin injection. The secondary success rate was 96.4% (53 of 55 pseudoaneurysms). There were no complications. US-guided thrombin injection was most successful within the first two weeks, and the supplemental compression might aid in the closure of partially thrombosed pseudoaneurysms.

A Case of Brachial Artery Pseudoaneurysm Due to an Infected Reservoir Port

A Case of Brachial Artery Pseudoaneurysm Due to an Infected Reservoir Port

Brachial artery pseudoaneurysm, a late complication of humeral non-union

Introduction We present a case of a pseudoaneurysm of the brachial artery arising due to a bone spike of a mobile non-union of a fracture of the humerus.

Delayed Presentation of a Brachial Artery Pseudoaneurysm After a Supracondylar Humerus Fracture in a 6-year-old Boy: A Case Report

Supracondylar fractures of the humerus are the most common elbow fractures in children, accounting for 60% to 70% of all pediatric elbow fractures. These fractures often have neurovascular complications because of deformity and the sharp nature of the fracture fragments. The management of patients who present with diminished or absent pulses, but a well-perfused extremity is a topic of debate. Between 3% and 14% of patients present with an altered vascular examination and a consistent treatment logarithm has not been proposed in the literature. To our knowledge, a brachial artery pseudoaneurysm presenting in a delayed fashion in the setting of a normal vascular examination has not been reported. We report a 6-year-old boy who had a delayed presentation of a brachial artery pseudoaneurysm after a supracondylar humerus fracture, which was repaired with a saphenous vein graft. This is to emphasize close neurological and vascular monitoring even in the setting of a well-perfused hand. In addition, this would suggest that closer postoperative evaluation in significantly displaced fractures should be performed, even beyond the fracture healing stage.

Two Cases of Silent Superior Vena Cava Syndrome associated with Vascular access and End-Stage Renal Disease

Due to the unavoidable use of indwelling devices and the magnitude of the operative problems encountered, superior vena cava syndrome (SVCS) has become a serious threat for patients with a history of multiple catheter placements. True diagnosis sometimes is not available due to paucity of symptoms or due to the inadequate considerations of the disease. Particularly in patients with chronic kidney disease, the evidence of central venous occlusion dictates the avoidance of placing peripheral dialysis access in this extremity. In this article, we report two patients (case 1- a patient with end stage renal disease and case 2 - a patient with chronic kidney disease) with silent SVCS related to stenosis resulting from indwelling pacemaker leads. Furthermore, the first patient had an extrinsic factor of compression, a brachial artery pseudoaneurysm - which although it was not causative - it may certainly have contributed to the development of SVCS. The brachial artery pseudoaneurysm restricted even more the flow to cephalic vein and consequently to superior vena cava. Though pacemaker leads have been well identified previously in the literature as a cause of the SVCS, the brachial artery pseudoaneurysm causing extrinsic compression constitutes a novel factor. Through the publication of this paper the awareness of SVCS in these patients shall be definitely enhanced. Moreover, physicians, nurses and patients shall be educated regarding the requirement for peripheral vein presentation in chronic kidney disease.

The treatment of complications of endovascular repair of aortic dissection

To discuss the experience with special consideration for the occurrence and management of complications after thoracic aortic stent-graft treatment (EVAR). Retrospectively review the 33 cases with complications following EVAR from July 2002 to March 2008. There were 21 male patients and 12 female patients with a mean age of 46.3 years and mean postoperative period of 12.3 d. There were 5 cases with left carotid artery covered, 5 cases with proximal or distal endoleak, 4 cases with limbs artery injuries, 3 cases with entire stent in false lumen, 3 cases with retrogression dissections, and 2 cases with Stanford A type dissection. In addition, there were 1 case of acute cerebral infarction during the procedure, 1 case of cerebral haemorrhage 2 d after endovascular repair and 1 case of pseudoaneurysm of the left brachial artery. The procedures for the complications included second stent grafts placement in 13 cases, right-left carotid and left carotid-subclavian bypass in 7 cases, iliac-femoral artery repair or graft implantation in 4 cases, abdominal aortic dissection windowing in 2 cases, one artery thrombectomy and one Beutall's procedure. Follow-up consisted of a CTA, MRI and office visit at 1, 6, 12 months and yearly thereafter. All the endoleak and retrogression dissections disappeared after secondary endovascular procedure. The ischemic complication of limbs, central nervous system and intestinal were cured after artery bypass. One case died of cardiac tamponade due to Stanford A aortic dissection and another case died of cerebral hemorrhage. The complication should be corrected as soon as possible and it might get more success to combine the endovascular approach and open surgery. Meanwhile, enhanced follow-up would help to find correlative complications in time.

The brachial artery: A critical access for endovascular procedures

The brachial artery is often used for coronary angiography. However, data on brachial access for aortic and peripheral interventions are limited. This study evaluated our experience with brachial artery catheterization for diagnostic arteriography and endovascular interventions. Between August 2004 and August 2005, 2026 endovascular procedures were performed. Of these, 323 cases (16%) in 289 patients required brachial artery access, forming the basis for this study. Patients who underwent multiple interventions, but with a single access (ie, thrombolysis), were considered a single case. Demographic and clinical data were recorded in a database and analyzed using logistic regression analyses with generalized estimating equations and the Fisher exact test for nominal variables. The mean age of all patients was 66.4 years, with 57% men. Brachial access was used for diagnostic purposes in 27% and for interventions including angioplasty, stenting, and thrombolysis in 73%. The use of brachial access was considered obligatory in 40%, adjunctive in 19% (ie, endovascular repair of abdominal aortic and thoracic aortic aneurysms) and preferential to femoral access in 41%. In 91% of patients, the brachial arteries were accessed percutaneously, and 9% underwent surgical cutdown for access. In patients whose brachial artery was approached percutaneously, access was achieved in all but one (99.6% technical success rate). Hemostasis after catheterization was achieved by manual compression in 89%. Operative mortality rate was 6.2% and not related to brachial artery access. Brachial access site-related complications occurred in 21 patients (6.5%). Thirteen of these 21 patients (62%) required a surgical correction, mostly for brachial artery thrombosis or pseudoaneurysm. Patients with complications were more commonly women (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.68-13.26; P = .003) and had a long interventional sheath (OR, 6.7; 95% CI, 1.53-29.07; P = .012). The risk of a brachial artery complication was not associated with thrombolysis, procedure type, vascular territory treated, or the use of heparin. No upper extremity limb or finger loss occurred. Brachial artery access is necessary for complex endovascular procedures and can be achieved in most patients safely. Postprocedural vigilance is warranted because most patients with complications will require operative correction.

Brachial Artery Pseudoaneurysms Caused by Inadvertent Hemodialysis Access Needle Punctures

The preferred access for hemodialysis is a native autogenous arteriovenous fistula because fistulas have lower complication rates and better longevity compared with prosthetic grafts.1 However, fistulas are inclined to develop such complications as aneurysm, pseudoaneurysm, venous stenosis, venous hypertension, thrombosis, hemorrhage, arm edema, steal syndrome, and infection.2 Pseudoaneurysm in the brachial artery is a rare complication of hemodialysis therapy. We report the case of a man who presented with several small brachial artery pseudoaneurysms because of repeated inadvertent needle punctures of the brachial artery during access of the arteriovenous fistula.

The efficacy and safety of closure of brachial access using the AngioSeal closure device: Experience with 161 interventions in diabetic patients with critical limb ischemia

This study retrospectively evaluated the efficacy and safety of the 6F Angio-Seal (St. Jude Medical, St. Paul, Minn) as a closure device for transbrachial artery access for endovascular procedures in diabetic patients with critical limb ischemia. From January 2005 and September 2007, 1887 diabetic patients underwent interventional procedures in the lower limbs at a two diabetic foot centers. Patients presented with rest pain (16%), ulcers (80%), or gangrene (4%). Systemic anticoagulation with sodium heparin (70 IU/kg) was obtained for all patients at the beginning of the endovascular treatment. A total of 249 brachial arteries (238 patients) were evaluated for possible Angio-Seal use after endovascular recanalization of the leg. Color Doppler ultrasound imaging of the artery was obtained before revascularization only in patients with previous Angio-Seal placement in the brachial artery. No further imaging studies were done in the remaining brachial arteries where the Angio-Seal was deployed at the operator's discretion. Impairment or disappearance of the radial pulse or onsets of hand ischemia or hand pain, or impairment of hand function during or at the end of the endovascular revascularization were all regarded as contraindications to Angio-Seal usage. Evidence of a highly calcified plaque of the brachial artery access site at the time of vessel puncture was regarded as an absolute contraindication to the Angio-Seal use. Patients were seen before discharge, at 1, 3, and 8 weeks after the procedure, and at 3-month intervals thereafter. Complications included hemorrhage, pseudoaneurysm, infection, and vessel occlusion. A total of 1947 Angio-Seal collagen plugs were deployed in 1709 diabetic patients (90.5%). The Angio-Seal was used for brachial artery closure in 159 patients (8.4%) in 161 procedures (159 in the left, 2 in the right brachial artery). In 79 patients (4.2%) in 88 procedures (87 in the left and 1 in the right brachial artery), the device was deemed contraindicated due to small vessel size in 73 patients (92.4%) or presence of calcium at the access site in five patients (6.3%). One patient (1.3%) refused the collagen plug closure after revascularization. The non-Angio-Seal group was evaluated for comparison. The success rate for achieving hemostasis in the Angio-Seal group was 96.9%. Five major complications (3.1%) at 30 days consisted of two puncture site hematomas >4 cm, two brachial artery occlusions, and one brachial artery pseudoaneurysm, with three patients requiring open surgery. Minor complications (7.50%) were three puncture site hematomas < 4 cm, three oozing of blood from the access site, and six patients had mild pain in the cubital fossa. No further complications were recorded in the 14-month follow-up (range 1-25 months) of a total of 140 patients. This retrospective study shows that the 6F Angio-Seal is a valuable and safe vascular closure device for transbrachial access in diabetic patients undergoing interventional procedures for critical limb ischemia.

Pseudoaneurysm of the Brachial Artery Following Humeral Fracture

The frequency of peripheral artery aneurysms in the upper extremities is less than in the lower extremities. Diagnosis and surgical treatment are important because upper extremity aneurysms can severely compromise the function of a limb and possibly lead to the loss of an arm or fingers. Very rarely, posttraumatic upper extremity pseudoaneurysms show symptoms after a long period of time. Diagnosis can be made on review of the patient's history and a physical examination. Surgical reconstruction is the preferred treatment for such patients. We present a case of a brachial artery pseudoaneurysm following humeral fracture.