# 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.

## Key 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.