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

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Abstract

Background

A 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 presentation

A 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.

Conclusions

High 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.

Related collections

Most cited references 14

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Management of true aneurysms distal to the axillary artery.

Richard Gray, William M Stone, Richard J Fowl … (1998)

To delineate management strategies and outcomes for true aneurysms involving arteries of the upper extremity distal to the axillary artery. The management of these rare lesions has not been well established in the literature. Retrospective chart review was performed at tertiary referral centers. All patients who received the diagnosis of true upper extremity aneurysms distal to the axillary artery between 1975 and 1995 were included in the review. Nineteen patients were found; seven were excluded because no confirmatory diagnostic imaging study or operative exploration was performed. This represents the largest reported series of true upper extremity arterial aneurysms. Twelve patients (9 men or boys) had 12 confirmed true aneurysms of the brachial or more distal arteries. The average diameters were as follows: brachial artery 4.6 cm, radial artery 2.0 cm, ulnar artery 1.4 cm, and digital artery 0.8 cm. The mean age was 51 years (range, 10 to 86 years). The most common presentation was the presence of a mass. This occurred among eight patients (67%). Four patients (33%) reported pain or paresthesia. One patient (8%) had cold intolerance only. Three patients (25%) had thromboembolic complications. Complications did not consistently correlate with size or presence of intramural thrombus. Three aneurysms (25%) were initially managed nonoperatively and followed for a mean period of 71 months. One of these required operative repair after 5 months because of progressive pain. Ten patients (83%) were treated surgically as follows: five underwent ligation and excision only, and five underwent excision and revascularization. Morbidity was minimal, and there were no perioperative deaths. True arterial aneurysms of the upper extremity distal to the axillary artery are rare and most commonly caused by blunt trauma. Fifty-eight percent of these lesions present with symptoms or complications. Thirty-three percent of asymptomatic lesions later become symptomatic. These factors combined with the minimal morbidity associated with repair suggest that operative repair should be routinely performed for these aneurysms. Revascularization can be performed selectively.

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Post-traumatic pseudoaneurysm of the brachial artery and its surgical treatment.

Ufuk Yetkin, Ali Gurbuz (2002)

The frequency of peripheral artery aneurysms in the upper extremities is much less than in the lower extremities. Diagnosis and surgical treatment are important because upper extremity aneurysms can cause severe decreases in function and lead to the loss of an arm or of fingers. We performed aneurysmal resection together with saphenous vein graft interpositioning in 9 patients with a diagnosis of post-traumatic brachial pseudoaneurysm from January 1995 through February 2003. Of these patients, 7 were men (77%). The mean age was 38.2 years (range, 26-46 years. Four patients had gunshot wounds (44%) and 5 had stab wounds (56%). The mean duration from injury to hospital admission was 26.7 months (range, 17 months-7 years). All patients underwent color-flow arterial Doppler ultrasonography and selective upper extremity digital subtraction angiography. In all patients, we performed aneurysmal resection and saphenous vein graft interpositioning. There was no instance of death or ischemic extremity loss. Patients were discharged from the hospital a mean of 3.2 days after surgery (range, 2-6 days). Early and late graft patency rates were 100%. We followed the patients' cases for a mean of 3.4 years (range, 1 month-7 years). Very rarely, post-traumatic upper extremity pseudoaneurysms show symptoms after a long period of time. Diagnosis is very easy with a review of the patient's history and a physical examination; surgical reconstruction is the preferred treatment for such patients.

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Brachial arteriomegaly and true aneurysmal degeneration: case report and literature review.

Richard T. Sullivan, Christian Schunn (2002)

While brachial artery aneurysms are rare and usually of infectious, post-traumatic or iatrogenic etiology, true aneurysms of the brachial artery are even more unusual. We report on a large brachial artery aneurysm complicated by chronic contained rupture and partial outflow obstruction. This was observed 19 years after ligation of a radiocephalic (Brescia-Cimino) arteriovenous fistula for hemodialysis that had existed for 2 years. Of 581 brachial artery reconstructions performed at the Cleveland Clinic Foundation between January 1989 and December 2000, only three involved repairs of brachial artery aneurysms; only the reported case was a true aneurysm of degenerative origin for an incidence of 0.17% (1/581). The management of brachial artery aneurysms is described and the pertinent literature was reviewed.

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Author and article information

Contributors

Satoshi Toyota: sa-toyoda@nakatsu-hosp.jp

Kentaro Inoue:

ORCID: http://orcid.org/0000-0001-5910-7011

k_inoue@surg2.med.kyushu-u.ac.jp

Shun Kurose: skurose@surg2.med.kyushu-u.ac.jp

Shinichiro Yoshino: syoshino@surg2.med.kyushu-u.ac.jp

Ken Nakayama: ken_n@surg2.med.kyushu-u.ac.jp

Sho Yamashita: sho_y@surg2.med.kyushu-u.ac.jp

Koichi Morisaki: morisaki@surg2.med.kyushu-u.ac.jp

Tadashi Furuyama: (+81) 92-642-5466 , cdq43210@par.odn.ne.jp

Masaki Mori: m_mori@surg2.med.kyushu-u.ac.jp

Journal

Journal ID (nlm-ta): Surg Case Rep

Journal ID (iso-abbrev): Surg Case Rep

Title: Surgical Case Reports

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Electronic): 2198-7793

Publication date (Electronic): 4 December 2019

Publication date PMC-release: 4 December 2019

Publication date Collection: December 2019

Volume: 5

Electronic Location Identifier: 188

Affiliations

ISNI 0000 0001 2242 4849, GRID grid.177174.3, Department of Surgery and Science, Graduate School of Medical Sciences, , Kyushu University, ; 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582 Japan

Author information

Kentaro Inoue http://orcid.org/0000-0001-5910-7011

Article

Publisher ID: 724

DOI: 10.1186/s40792-019-0724-4

PMC ID: 6892993

PubMed ID: 31802273

SO-VID: d26add67-7a83-404f-8892-5455ad317217

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 13 June 2019

Date accepted : 2 October 2019

Custom metadata

Keywords: brachial artery aneurysm,renal transplantation,arteriovenous fistula

Data availability:

Keywords: brachial artery aneurysm, renal transplantation, arteriovenous fistula

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

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