Giant 20 × 35 cm brachial artery pseudoaneurysm after fistulogram treated with surgical resection of pseudoaneurysm and patch angioplasty of brachial artery

TL;DR

A rare case of a large brachial artery pseudoaneurysm in a dialysis patient was successfully treated with surgical resection and patch angioplasty.

Contribution

Presents a novel surgical approach for treating a giant pseudoaneurysm without bypass in a patient with limited vascular options.

Findings

A 20 × 35 cm pseudoaneurysm was successfully resected surgically.

Patch angioplasty was used instead of bypass due to limited autogenous vein availability.

The patient's postoperative course was uneventful with preserved dialysis access.

Abstract

Brachial artery pseudoaneurysms are a rare entity, which can occur secondary to infectious, traumatic, or iatrogenic causes. We present a 78-year-old female with end-stage renal disease on hemodialysis via a right brachio-basilic arteriovenous fistula. She had previously undergone numerous fistulograms and endovascular interventions for right upper extremity swelling due to prolonged bleeding following dialysis. After a recent fistulogram she developed recurrent arm swelling. Duplex showed a large hematoma without any evidence of vascular flow. However, intraoperatively, she was noted to have a giant 20 × 35 cm pseudoaneurysm of the brachial artery. Therapeutic options include endovascular stenting, embolization, thrombin injection, ultrasound-guided compression, and surgery. We elected to perform resection of the large pseudoaneurysm and arteriovenous fistula ligation due to the large size. Given her end-stage renal disease status and lacking quality autogenous vein, we were able to perform a patch angioplasty repair of her brachial artery without requiring a bypass.

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