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Abstract. Haemodialysis patients carry a high risk of pseudoaneurysm due to inadvertent puncture of the brachial artery
during venous cannulation for haemodialysis.
Signs and symptoms are pulsatile mass and a systolic murmur. Complications are rupture, infection, haemorrhage, dis-
tal arterial insufficiency, venous thrombosis and neuropathy. Early diagnosis is essential to plan adequate treatment.
Doppler US and angiography usually confirm the lesion accurately. Ultrasound guided compression, percutaneous
injection of thrombin, endovascular covered stent exclusion, aneurysmectomy and surgical repair are different treatment
options.
We report clinical and radiological findings and treatment strategies in four dialysed patients who developed brachial
artery pseudoaneurysms.
Fig. 1 Fig. 3
Photography of the infected pseudoaneurysm Power Doppler sonogram reveals patent pseudoaneurysm orig-
inating from brachial artery.
Case 3
It was a 38-year old hypertensive patient with an AVF at
the right snuff-box region. He was receiving haemodial-
ysis treatment three times a week for about 3 years. One
day after a regular haemodialysis session, we found that
a subcutaneous mass had developed at the blood access
puncture point, above the brachial artery at the antecu-
bital region. Color DUS was performed and a 4
4 cm pulsating haematoma originating from the brachial
artery was observed. Brachial artery laceration was con-
firmed at surgery and a 2 mm defect on the arterial wall
was primarily sutured. The postoperative control DUS
Fig. 2 showed satisfactory patency of the brachial artery.
Color Doppler sonogram shows partially thrombosed large
pseudoaneurysm.
Case 4
It was a 35-year old male patient who has been under-
days after the haemodialysis, a mass in the left antecu- going haemodialysis for 3 years ; three times a week
bital fossa appeared. The color and power DUS docu- through a Brescio-Cimino AVF. Seven days after a
mented an 80 63 mm pulsating haematoma, origi- haemodialysis session, a mass in the left antecubital
nating from the anterior wall of the brachial artery fossa was observed. Color DUS and brachial artery
(Fig. 3). Ultrasound-guided compression repair (UGCR) angiography were performed and showed a 6 3.5 cm
was attempted but was unsuccessful. During surgery, pseudoaneurysm originating from the brachial artery
brachial artery pseudoaneurysm and a 1 cm defect on (Fig. 4). The patient underwent surgical repair and the
the arterial wall were confirmed. Furthermore, a partial pseudoaneurysm was evacuated. The 2 mm defect on the
thrombus in the brachial artery and a complete obstruct- arterial wall was primarily repaired. There were no addi-
ing thrombus in the radial artery were present. tional circulatory problems after the operation.
Thrombectomy was performed with a 4F Fogarty
catheter and the arterial wall defect was repaired with an Discussion
autologous vein graft. Systemic anticoagulation with
heparin was started postoperatively. One day after the The most frequent iatrogenic complication after diag-
operation, ischaemic changes were observed at the 4th nostic, therapeutic, or accidental punctures of the vascu-
and 5th digits, which were amputated 1 week after the lar system are pseudoaneurysms and AVF (1). Pseudo-
operation. Three months after the operation there were aneurysm is an infrequent, but well-documented
no additional problems and satisfactory outcome of the complication of the femoral and brachial artery
surgery was confirmed by color DUS. catheterization used in complex percutaneous vascular
192 S. Yildirim et al.
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