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Grande-Garcia R, Anaya-Ayala JE, Barragán-Galindo L, Vera R, Laparra-Escareno H, Varela-Arzate A, Chapa-Ibargüengoitia M, Hinojosa CA. Ischemic Complication of a Rare Traumatic True Brachial Artery Aneurysm: A Case Report. Vasc Specialist Int 2024; 40:4. [PMID: 38311376 PMCID: PMC10839554 DOI: 10.5758/vsi.230100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 02/07/2024] Open
Abstract
True brachial artery aneurysms are rare. We present the case of a 47-year-old male who was referred to our clinic for the evaluation of progressive right arm claudication. He had suffered a gunshot wound in the right elbow 16 years before his symptoms. Computed tomography angiography revealed a thrombosed true brachial artery aneurysm. The patient was placed in the operating room, and aneurysm resection and reconstruction were performed using an interposition saphenous vein graft. His postoperative period was uneventful, and 1 year after the procedure, he remained asymptomatic. True brachial artery aneurysms associated with remote traumas are rare. This case illustrates the clinical presentation and successful management of arterial reconstruction using an autologous vein graft.
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Affiliation(s)
- Ricardo Grande-Garcia
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Javier E. Anaya-Ayala
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis Barragán-Galindo
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Renata Vera
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hugo Laparra-Escareno
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Astrid Varela-Arzate
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mónica Chapa-Ibargüengoitia
- Departments of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A. Hinojosa
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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La Marca MA, Dinoto E, Rodriquenz E, Pecoraro F, Turchino D, Mirabella D. Brachial artery aneurysm after hemodialysis fistula ligation: Case reports and review of literature. Int J Surg Case Rep 2024; 115:109306. [PMID: 38280341 PMCID: PMC10839962 DOI: 10.1016/j.ijscr.2024.109306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION Brachial artery aneurysm (BAA) following long-standing arteriovenous fistula (AVF) ligation after renal transplantation is odd. CASE PRESENTATION Two cases of brachial artery aneurysm treated with bypass (a saphenous vein graft and a PTFE graft). In the first patient no complications were recorded whereas an infection was diagnosed after 6 months from the procedure in the second treatment. CLINICAL DISCUSSION Multiple factors activated by stress on the vessel wall followed by fistula ligation are the cause of vascular remodeling of the three layers making up the wall with possible evolution in aneurysmatic lesions. In literature the gold standard for this lesion is the surgical approach, only one endovascular procedure is reported. The traditional surgical approach uses the autologous vein or prosthetic PTFE grafts. CONCLUSION Brachial artery aneurysm is a complication that affects patients undergoing renal transplantation who have already undergone AVF ligation. In our experience autologous vein graft represented the best solution.
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Affiliation(s)
- M A La Marca
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - E Dinoto
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy.
| | - E Rodriquenz
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - F Pecoraro
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences - University of Palermo, Italy
| | - D Turchino
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - D Mirabella
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
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Doita T, Yamasumi T, Nakamura T. Thrombosis related to true axillo-brachial arterial aneurysm following ligation of longstanding arteriovenous fistula for hemodialysis. J Vasc Surg Cases Innov Tech 2023; 9:101334. [PMID: 37965111 PMCID: PMC10641672 DOI: 10.1016/j.jvscit.2023.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/09/2023] [Indexed: 11/16/2023] Open
Abstract
A 52-year-old man who had received hemodialysis via a left radial-cephalic arteriovenous fistula (AVF) for 18 years presented with severe ischemic symptoms in the left upper arm 12 years after occlusion of the AVF. Diagnostic imaging revealed thrombotic occlusion from a left axillary-brachial artery aneurysm, which required distal bypass surgery. The inflow artery of an AVF can develop aneurysmal degeneration, resulting in upper limb ischemia by embolization or decreased flow, especially with a ligated or occluded AVF or immunosuppressive therapy after renal transplantation. In such cases, the AVF should be monitored, even if ligated or occluded.
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Affiliation(s)
- Tsutomu Doita
- Department of Vascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Taro Yamasumi
- Department of Vascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Takashi Nakamura
- Department of Vascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
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Zahdi O, El Bhali H, Taous H, Bahij Y, El Khloufi S, Sefiani Y, El Mesnaoui A, Lekehal B. [Brachial artery aneurysm in kidney transplant patient after distal fistula closure]. Nephrol Ther 2022; 18:291-293. [PMID: 35606315 DOI: 10.1016/j.nephro.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 11/16/2022]
Abstract
Brachial artery aneurysmal degeneration is an exceptional complication of distal native fistulas. Chronic mechanical stresses due to high flow, as well as immunosuppressants drugs following renal transplantation, are the mains factors implicated in the pathophysiological mechanism. We report a case of a transplant patient with a true, symptomatic, brachial artery aneurysm, 8 years after transplantation and 5 years after radiocephalic wrist fistula ligation. The patient underwent open surgical repair, with aneurysm resection and end-to-end anastomosis. We present a literature review of the different therapeutic strategies of this unusual entity.
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Affiliation(s)
- Othman Zahdi
- Université Mohammed V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Souissi, 10104 Rabat, Maroc.
| | - Hajar El Bhali
- Université Mohammed V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Souissi, 10104 Rabat, Maroc
| | - Hamza Taous
- Université Mohammed V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Souissi, 10104 Rabat, Maroc
| | - Youssef Bahij
- Université Mohammed V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Souissi, 10104 Rabat, Maroc
| | - Samir El Khloufi
- Université Mohammed V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Souissi, 10104 Rabat, Maroc
| | - Yasser Sefiani
- Université Mohammed V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Souissi, 10104 Rabat, Maroc
| | - Abbes El Mesnaoui
- Université Mohammed V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Souissi, 10104 Rabat, Maroc
| | - Brahim Lekehal
- Université Mohammed V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Souissi, 10104 Rabat, Maroc
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Barac S, Rata AL, Popescu AI, Onofrei RR, Chiriac SD. True Brachial Artery Aneurysm in Patients with Previous Arterio-Venous Fistula Ligation and Immunosuppressant Therapy for Renal Transplantation: Case Report and Literature Review. Healthcare (Basel) 2022; 10:470. [PMID: 35326948 PMCID: PMC8956084 DOI: 10.3390/healthcare10030470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVE Brachial artery aneurysm (BAA) is a serious complication in patients with previous arterio-venous fistula (AVF), renal transplantation (RT), and immunosuppressive regimens. Until now, there has been no standard of care for these patients, especially for patients undergoing chronic dialysis and immunosuppressive treatment. The aim of this study was to investigate data from the literature regarding these patients and to suggest recommendations for the best approach to their treatment. METHODS A review of the literature was performed by searching the PubMed database in the English language. The review was accompanied by two case reports. A total of 24 articles with different variables-demographics, renal transplantation, aneurysm size, and type of surgery-were subjected to the review. In addition, two cases are reported. CONCLUSION This review suggests that the best treatment for these patients is open surgery, with aneurysmectomy and graft interposition. RESULTS All patients had RT. The age of patients ranged from 26-77 yo, with a male predominance. The majority had an AVF ligated after RT. The main clinical symptoms were pain, swelling, and pulsatile mass (66%). All patients, except one, were treated through open surgery. The first option for treatment was reversed saphenous vein graft interposition (36%), followed by ePTFE graft (16%).
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Affiliation(s)
- Sorin Barac
- Department of Vascular Surgery, Research Centre for Vascular and Endovascular Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Andreea Luciana Rata
- Department of Vascular Surgery, Research Centre for Vascular and Endovascular Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Alexandra Ioana Popescu
- Hospital Centre “Saint Nicolas”, “Victor Babes” University of Medicine and Pharmacy Timisoara, 57400 Sarrebourg, France;
| | - Roxana Ramona Onofrei
- Department of Rehabilitation, Physical Medicine and Rheumatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Research Center for Assessment of Human Motion, Functionality and Disability, 300041 Timisoara, Romania;
| | - Sorin Dan Chiriac
- 3rd Surgery Department, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
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Bautista-Sánchez J, Cuipal-Alcalde JD, Bellido-Yarlequé D, Rosadio-Portilla L, Gil-Cusirramos M. True Brachial Aneurysm in an Older Female Patient. A Case Report and Review of Literature. Ann Vasc Surg 2021; 78:378.e1-378.e8. [PMID: 34455052 DOI: 10.1016/j.avsg.2021.05.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Brachial artery aneurysms constitute 0.5% of peripheral aneurysms. These can be true or secondary to trauma or arteriovenous fistulas. These present as an asymptomatic pulsatile mass or may cause symptoms due to compression of adjacent neurological structures. CASE REPORT We present a review of the literature on clinical, histological, and therapeutic characteristics of true brachial aneurysms, motivated by the case of a 67-year-old woman with an asymptomatic pulsatile mass dependent on the brachial artery of the left arm who underwent open surgical correction with resection of the aneurysmal sac and interposition of great saphenous vein graft with adequate postoperative results.
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Affiliation(s)
| | | | | | - Luz Rosadio-Portilla
- Vascular Surgery Unit, Guillermo Almenara Irigoyen National Hospital, Lima, Perú.
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Hamdulay KA, Laws PE, Ruiz CM. Primary brachial artery aneurysm with associated basilic vein aneurysm. J Surg Case Rep 2021; 2021:rjab056. [PMID: 33815750 PMCID: PMC8007162 DOI: 10.1093/jscr/rjab056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
There are but a handful of reported brachial artery aneurysms, the majority of which are pseudoaneurysms or false aneurysms caused by trauma or fistula creation. True or primary brachial artery aneurysms are even more rare, and if they occur, they often do so in isolation. In this case report, we discuss the interesting finding of a large primary brachial aneurysm together with an adjacent aneurysmal basilic vein identified intra-operatively. This presentation was 21 years after the renal transplant and ligation of an arteriovenous fistula in that same arm. It is noteworthy that the fistula was in the forearm and far away from the site of the untouched brachial area.
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Affiliation(s)
- Khaleel A Hamdulay
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Peter E Laws
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Carmen M Ruiz
- Department of Vascular Surgery, Nelson Hospital, Nelson Marlborough District Health Board, Nelson, New Zealand
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The Role of Immunosuppressive Therapy in Aneurysmal Degeneration of Hemodialysis Fistulas in Renal Transplant Patients. Ann Vasc Surg 2021; 74:21-28. [PMID: 33567296 DOI: 10.1016/j.avsg.2021.01.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Venous aneurysms are long-term complications of arteriovenous fistula (AVF) for hemodialysis with an estimated incidence rate of around 5-6%. The purpose of our study is to investigate the role of immunosuppressive therapy in the development of AVF aneurysms in renal transplant patients, and to determine whether AVF closure following transplantation is necessary. METHODS Forty-six patients with symptomatic venous AVF aneurysms underwent ligation and resection of their fistulas between January 2013 and January 2020. Immunohistochemical expression of CD3, CD4, and CD8 was assessed on the surgical specimens to characterize lymphocytic infiltrate in the aneurysm wall. Patients were subdivided into "Group A"-kidney transplant patients undergoing immunosuppressive therapy which was comprised of 39 patients and "Group B"-patients who had not undergone kidney transplant which was comprised of 7 patients. The 2 groups did not significantly differ in age, sex nor risk factors for aneurysms. RESULTS Group A showed a significantly higher aneurysm diameter (P < 0.0001), mean flow (P < 0.0001) and required a longer duration of surgery (P = 0.0007). A CD3+ lymphocytic infiltrate was significantly more common in Group A than in the Group B (90% vs 29%; P < 0.001). No significant differences in localization (adventitia, media or intima) and type (CD4+ vs CD8+) of lymphocytes were found between the 2 groups. CONCLUSION AVF venous aneurysms were significantly larger and with a more intense T-lymphocytic infiltrate in patients undergoing immunosuppressive therapy. This finding suggests that immunosuppressive therapy plays a role in aneurysm formation, supporting the need for AVF closure in patients with an estimated low risk of rejection.
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Nasser Eldine R, Dehaini H, Hoballah JJ, Haddad FF. Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature review. BMC Surg 2020; 20:177. [PMID: 32758209 PMCID: PMC7430811 DOI: 10.1186/s12893-020-00833-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic arteriovenous fistula (TAVF) is an uncommon vascular entity that arises in various locations, often from penetrating injuries, with a wide spectrum of signs and symptoms. This case report highlights the importance of suspecting multiple TAVFs after a single gunshot wound, especially if it involves pellets. It also sheds light on adapting treatment, whether endovascular or open repair, to the location and characteristics of each fistula. Case presentation A 35-year-old male, with history of shotgun wound 5 months earlier, presented to our clinic with right lower extremity (RLE) edema and pain. Arterial duplex scan and subsequent angiogram showed two TAVFs at the popliteal and posterior tibial (PT) arteries, both of which could not be exactly localized with a computed tomography angiography (CTA) due to artifacts. The fistula connecting the posterior tibial artery (PTA) and vein was repaired endovascularly using a covered-stent, while the fistula between the popliteal artery and vein was repaired surgically. Postoperative follow-up at 3 months showed no arteriovenous fistula (AVF), patent vessels and distal stent stenosis at the PTA. Conclusions Patients who sustain gunshot injuries with shrapnel or pellets and develop TAVF consequentially need to be followed up with the possibility of multiple AVFs in mind. Arterial duplex scan is highly sensitive to detect those AVFs, yet angiography remains gold standard, particularly with extensive metal artefacts. Endovascular repair, when feasible, should be considered first, unless the patient is unstable or has anatomical constraints that increase the risk of complications. Lastly, surgeons should be weary of deep venous thrombosis (DVT), the Branham effect and arterial aneurysmal dilation postoperatively.
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Affiliation(s)
- Rakan Nasser Eldine
- Division of Vascular & Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Riad el Solh, Beirut, 1107 2020, Lebanon
| | - Hassan Dehaini
- Division of Vascular & Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Riad el Solh, Beirut, 1107 2020, Lebanon
| | - Jamal J Hoballah
- Division of Vascular & Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Riad el Solh, Beirut, 1107 2020, Lebanon
| | - Fady Fayez Haddad
- Division of Vascular & Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Riad el Solh, Beirut, 1107 2020, Lebanon.
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