A case of brachial artery pseudoaneurysm requiring endovascular therapy twice

Recurrence of brachial artery pseudoaneurysm

Abstract

Brachial artery pseudoaneurysm (BAP) is a complication that can result from trauma, iatrogenic injury, or drug abuse, and can have serious consequences for the limb and overall health, including hemorrhage, nerve injury, venous edema, loss of limb function, and rupture. This paper describes a case of BAP that developed following the first hemostasis procedure and required a second endovascular therapy (EVT) procedure. The patient in this case had an iatrogenic brachial artery pseudoaneurysm (BAP) that appeared 10 days after coronary angiography. The patient experienced swelling and pain in the left upper limb, prompting emergency hemostasis with EVT. Percutaneous thrombin injection was administered, along with balloon inflation, and angiography confirmed successful hemostasis. However, 16 days after the initial EVT, the patient returned to the hospital with the same symptoms, and a recurrence of BAP was observed on duplex ultrasound. Stent graft implantation was required due to vessel structure disruption detected by intravascular ultrasound imaging. Following stent graft deployment, a final angiogram showed that the pseudoaneurysm had disappeared, and the patient experienced no complications for three months. This case highlights the importance of observing vascular structure with intravascular ultrasonography (IVUS) to predict successful hemostasis, and suggests that additional therapy should be considered when the structure is disrupted.