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Muhammad NA, Samad A, Abdul Rehman M, Yusuf S, Abdul Rahman Z. Median Nerve Palsy Caused by a Brachial Artery Pseudoaneurysm Following an Acute Penetrating Trauma. Cureus 2024; 16:e69254. [PMID: 39398798 PMCID: PMC11470433 DOI: 10.7759/cureus.69254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2024] [Indexed: 10/15/2024] Open
Abstract
Arterial pseudoaneurysms are uncommon vascular lesions resulting from a breach in the arterial wall leading to contained haematoma formation, often associated with trauma or iatrogenic procedures. Brachial artery pseudoaneurysms following acute penetrating trauma are rare, with even fewer cases presenting with associated median nerve complications. We present the case of a 41-year-old man who developed median nerve palsy secondary to a brachial artery pseudoaneurysm following a knife stab wound to his left cubital fossa. Initially, the pseudoaneurysm was undiagnosed, and the patient experienced worsening symptoms, leading to further investigation and subsequent surgical repair of the pseudoaneurysm. This case underscores the importance of considering vascular injuries and their delayed sequelae in cases of penetrating trauma, particularly when associated with neurological deficits. Prompt diagnosis and intervention are crucial to prevent potential complications and optimise patient outcomes. The utilisation of appropriate imaging modalities, such as Doppler ultrasonography and CT angiography, facilitates accurate diagnosis and guides tailored management strategies. Further research is warranted to explore optimal treatment approaches and long-term outcomes in similar cases.
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Affiliation(s)
- Naasik A Muhammad
- Emergency Department, Evercare Hospital Lahore, Lahore, PAK
- Medicine, Riphah International University, Islamabad, PAK
| | - Abdul Samad
- Diagnostic Radiology, Capital Hospital, Islamabad, PAK
- Medicine, Riphah International University, Islamabad, PAK
| | | | - Shazia Yusuf
- Diagnostic Radiology, Capital Hospital, Islamabad, PAK
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Rahman NA, Wang A, Chihade DB, Feghali A. Giant 20 × 35 cm brachial artery pseudoaneurysm after fistulogram treated with surgical resection of pseudoaneurysm and patch angioplasty of brachial artery. J Surg Case Rep 2024; 2024:rjae213. [PMID: 38572280 PMCID: PMC10989281 DOI: 10.1093/jscr/rjae213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 04/05/2024] Open
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.
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Affiliation(s)
- Naveed A Rahman
- Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States
| | - Alice Wang
- Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States
| | - Deena B Chihade
- Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States
| | - Anthony Feghali
- Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States
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Mannava AS, Braga AC, Fathollahpour A, Ryali N, Lazarevic M. Bullet Wound Blues: A Case Report on Brachial Artery Pseudoaneurysm. Cureus 2023; 15:e42408. [PMID: 37637527 PMCID: PMC10447913 DOI: 10.7759/cureus.42408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Pseudoaneurysms are typically iatrogenic due to the increasing use of the artery for arterial interventions such as invasive vascular radiological procedures, invasive coronary artery procedures, arterial punctures for an arteriogram, or catheterization. Other reasons for pseudoaneurysm formation are intravenous drug use and penetrating trauma. They are more commonly observed in the lower limbs than in the upper limbs. In this case report, we present the occurrence of a brachial artery pseudoaneurysm (BAP) in a 73-year-old male patient who suffered a gunshot wound (GSW) 25 years ago during the war and was admitted to the hospital because of a fall episode. This case represents one of the few documented instances of a pseudoaneurysm formation following a GSW in the United States. Along with that, we describe the subsequent medical care provided to the patient.
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Affiliation(s)
- Anjali S Mannava
- Department of Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Ana C Braga
- Department of Medicine, University of Brasilia, Brasilia, BRA
| | - Ayda Fathollahpour
- Department of Medicine, Iran University of Medical Sciences, Tehran, IRN
| | - Niharika Ryali
- Department of Medicine, Gandhi Medical College, Hyderabad, IND
| | - Milenko Lazarevic
- Department of Internal Medicine, Swedish Covenant Hospital, Chicago, USA
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Pseudoaneurysm of the brachial artery in an infant due to vaccination: a case report. BMC Pediatr 2023; 23:9. [PMID: 36600189 PMCID: PMC9814207 DOI: 10.1186/s12887-022-03793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Pseudoaneurysm is a known complication of penetrating arterial injuries such as catheterization, gunshot wounds, and open fractures. Vaccination is an effective method for preventing multiple, serious, infectious diseases in children. Common adverse reactions related to vaccination include fever, swelling, redness, and pain. Brachial pseudoaneurysm after vaccination has not been previously reported. CASE PRESENTATION Herein we describe a novel case of brachial pseudoaneurysm after vaccination in a child aged 1 year and 3 months. A pulsatile mass was formed in the medial left arm of the infant 10 days after vaccination at a community hospital and gradually grew larger. Preoperative images depicted an eccentric aneurysm in the brachial artery and a swirling flow pattern in the mass. The pseudoaneurysm was excised, and vein graft interpositioning was successfully performed. There were no short-term or long-term complications during the follow-up period. CONCLUSIONS Brachial pseudoaneurysm is a rare complication of vaccination via intramuscular injection. Medical staff should avoid puncture wounds to the brachial artery during vaccination, especially in infants.
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Sandoval-Clavijo A, Albero-González R, Toll A. Sudden Development of Indurated Subcutaneous Nodules in a Patient With a Recent Melanoma Surgical Procedure. JAMA Dermatol 2022; 158:318-319. [PMID: 35080589 DOI: 10.1001/jamadermatol.2021.5689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Raquel Albero-González
- Department of Pathology, Hospital Clínic, Centre de Diagnostic Biomedic, Barcelona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Profunda Brachii Pseudoaneurysm following Supracondylar Fracture of Humerus Repair in an 8-Year-Old Boy: A Case Report and Review of Literature. Case Rep Orthop 2021; 2021:1768529. [PMID: 34754522 PMCID: PMC8572625 DOI: 10.1155/2021/1768529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022] Open
Abstract
Arterial pseudoaneurysm can manifest in almost all arteries, but peripheral ones such as brachial artery pseudoaneurysm are rare and typically happen after trauma or infections. We describe an 8-year-old boy who presented with a large nonpulsatile soft tissue mass-like lesion 20 days after supracondylar fracture of the humerus which was fixed using Kirschner wire. The neurovascular examination was normal; CT angiography revealed a large pseudoaneurysm arising from the left profunda brachii artery. The patient went under surgical repair and was discharged from the hospital with an uneventful postop course. A high index of suspicion is necessary in cases with humeral fractures for the early diagnosis of pseudoaneurysm where the delayed diagnosis may cause fatal outcomes.
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Manzano G, Brown C, Harth K, Ochenjele G. Acute Presentation of a Pseudoaneurysm After a Proximal Humerus Shaft Fracture: A Case Report. JBJS Case Connect 2020; 10:e0131. [PMID: 32224663 DOI: 10.2106/jbjs.cc.19.00131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 69-year-old woman presented with a brachial artery pseudoaneurysm causing median, ulnar, and radial nerve compressive neuropathies 8 weeks after a proximal humerus shaft fracture treated with intramedullary nailing. She underwent a brachial artery bypass with a reverse cephalic vein interposition graft and neurolysis after decompression of a large pseudoaneurysm. Postoperatively, the patient had a normal vascular examination with recovering neurological function. CONCLUSIONS A high index of suspicion for a brachial artery pseudoaneurysm should be maintained in patients with a displaced proximal humerus shaft fracture, particularly when an abnormal neurovascular examination is present.
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Affiliation(s)
- Givenchy Manzano
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Corina Brown
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Karem Harth
- Department of Vascular Surgery and Endovascular Therapy, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - George Ochenjele
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio
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Abstract
The supracondylar humerus fracture is the most common elbow fracture in children, corresponding to 58% of these cases. The objective of this study is to report a rare postoperative complication, the pseudoaneurysm of the brachial artery. A 9-year-old girl with was admitted with a Gartland III supracondylar fracture of the right humerus, presenting normal neurological and vascular exams. The patient underwent a surgical treatment with percutaneous fixation and immobilization and was re-evaluated after 2 and 4 weeks. In the last evaluation the immobilization and fixation were removed. She returned after 3 months, presenting a progressive palpable, painless mass in the 1/3 distal right arm. The arterial ultrasound showed a mass in the cubital fossa, which presented internal flow and some wall thrombi, compatible with pseudoaneurysm of the brachial artery. After diagnosis, the treatment was a vascular surgery for dissection and reconstruction of the artery. The incidence of vascular involvement in Gartland III fractures ranges from 2% to 38%. False aneurysms originate from arterial hematomas caused by trauma to the arterial lumen, and their developing time can vary. There are few reports of this complication, so there is no consensus about the treatment.
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Isolated brachial artery aneurysm successfully treated with a covered stent in a patient with Behçet's disease. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:565-567. [PMID: 32082926 DOI: 10.5606/tgkdc.dergisi.2019.17852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/07/2019] [Indexed: 11/21/2022]
Abstract
Behçet's disease is a vasculitic pathology characterized by skin lesions, genital ulcers, aphthous stomatitis, and uveitis. Arterial aneurysms are rare in this disease. Herein, we report a rare case of an isolated brachial artery aneurysm with a history of Behçet's disease treated with endovascular covered stenting of the brachial artery.
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Lee AHH, Qi SD, Chiang N. Acute Upper Limb Ischemia Due to Delayed Presentation of a Brachial Artery Pseudoaneurysm Post-Venipuncture. Vasc Endovascular Surg 2019; 54:80-84. [PMID: 31533547 DOI: 10.1177/1538574419877620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brachial artery pseudoaneurysms (BAPs) are rare but could lead to complications of high morbidity. We report a case of a BAP presenting with hand ischemia and median nerve neuropathy nearly a decade after the inciting iatrogenic trauma, successfully treated with excision and direct repair. This report highlights that untreated pseudoaneurysms can be indolent and present late with both symptoms of embolization and local compression.
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Affiliation(s)
- Adele H H Lee
- Department of Vascular and Endovascular Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Vascular and Endovascular Surgery, The Austin Hospital, Melbourne, Victoria, Australia
| | - Sara D Qi
- Department of Vascular and Endovascular Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Vascular and Endovascular Surgery, The Austin Hospital, Melbourne, Victoria, Australia
| | - Nathaniel Chiang
- Department of Vascular and Endovascular Surgery, The Austin Hospital, Melbourne, Victoria, Australia
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Sungelo MJ, Sears BW. Delayed Radial Nerve Injury from a Brachial Artery Pseudoaneurysm Following a Four-Part Proximal Humerus Fracture: A Case Report and Literature Review. JBJS Case Connect 2019; 9:e0165. [PMID: 31498781 DOI: 10.2106/jbjs.cc.18.00165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE Following a 4-part proximal humerus fracture at the level of the surgical neck, an 84-year-old woman presented with delayed radial nerve deficits secondary to a brachial artery pseudoaneurysm. She underwent emergent repair of the vessel and reverse total shoulder arthroplasty. The deficit remained present at 1-year follow-up and is unlikely to improve. CONCLUSIONS Brachial artery pseudoaneurysms can occur following humeral fractures. Fractures at this location can lead to the unique complication of a proximal pseudoaneurysm that compresses the radial nerve. It should be considered a possible limb-threatening complication in fractures managed conservatively as well as surgical candidates.
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Affiliation(s)
- M J Sungelo
- University of Colorado School of Medicine, Aurora, Colorado
| | - B W Sears
- Western Orthopedics, Denver, Colorado
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Giant iatrogenic pseudoaneurysm of the brachial artery: A case report. Int J Surg Case Rep 2017; 37:193-195. [PMID: 28704745 PMCID: PMC5508487 DOI: 10.1016/j.ijscr.2017.06.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/17/2017] [Accepted: 06/18/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Pseudoaneurysms are a pulsatile hematoma caused by hemorrhage on soft tissues. It is an uncommon condition with many different etiologies. We report a case of a giant pseudoaneurysm caused by iatrogenic injury on the brachial artery. PRESENTATION OF CASE A 42 year-old male was submitted to our Vascular Surgery service with an enlargement of the right upper limb and a history of myocardial infarction. 60days before the patient reached our service, he was submitted to a cardiac catheterization performed by another medical team, since the catheter was placed on the right brachial artery near the cubital fossa, we suspected an iatrogenic pseudoaneurysm, which was confirmed by his clinical history and physical exam. It was opted to treat the pseudoaneurysm with an implant of polytetrafluoroethylene prosthesis. There were no complications whatsoever and the patient was discharged. DISCUSSION Pseudoaneurysms are more common after interventional procedures than diagnostic procedures, although brachial artery pseudoaneurysms are rare. Complications of pseudoaneurysms can cause serious threat to the afflicted limb and the patient's life. The management of any pseudoaneurysm is dependent on its size, location and pathogenesis. CONCLUSION Pseudoaneurysms develop slowly and should be diagnosed as early as possible in order to avoid complications and a better outcome. Due to an increase in recent endovascular procedures and the fact that brachial artery puncture is being performed more routinely, incidence of brachial artery pseudoaneurysms among overall population may rise.
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Yuksel A, Nas OF, Kan II, Tok M, Erdogan C. Percutaneous Coil Embolization for the Treatment of a Giant Brachial Artery Pseudoaneurym in a Child. Ann Vasc Surg 2017; 45:266.e5-266.e8. [PMID: 28689935 DOI: 10.1016/j.avsg.2017.06.139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 11/30/2022]
Abstract
Brachial artery pseudoaneurysm is a rare phenomenon. When a diagnosis of brachial artery pseudoaneurysm is established, early and appropriate treatment should be performed as soon as possible to prevent possible complications, such as hemorrhage, rupture, and upper limb and finger losses. Open surgical repair is usually the cornerstone of treatment; however, we here report a case of giant brachial pseudoaneurysm in a 2-year-old girl, which was successfully treated with percutaneous coil embolization.
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Affiliation(s)
- Ahmet Yuksel
- Department of Cardiovascular Surgery, Bursa State Hospital, Bursa, Turkey.
| | - Omer Fatih Nas
- Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Irem Iris Kan
- Department of Cardiovascular Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Mustafa Tok
- Department of Cardiovascular Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Cuneyt Erdogan
- Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey
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Klonaris C, Patelis N, Doulaptsis M, Katsargyris A. Hybrid Treatment of Large Brachial Artery Pseudoaneurysms. Ann Vasc Surg 2016; 32:20-4. [PMID: 26802294 DOI: 10.1016/j.avsg.2015.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/17/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Conventional surgical treatment of brachial artery pseudoaneurysms (BAPs) includes aneurysm excision/opening and subsequent arterial reconstruction with different options depending on the extent of the arterial deficit. Endovascular repair of BAPs with stent grafting has also been reported but published experience remains limited. In this report, we present our experience with a novel hybrid approach consisting of primary endovascular aneurysm exclusion with a stent graft and subsequent open surgical evacuation of pseudoaneurysm content for decompression of adjacent structures. METHODS This study included all patients who underwent hybrid repair of a BAP within the period 2005-2014 in our institution. Data were collected retrospectively. RESULTS During the study period a total of 5 patients with iatrogenic BAPs were treated. Mean BAP diameter was 58 ± 4.9 mm. Technical success was 100%. Thirty-day mortality was null. No major perioperative complications were noted. Hand ischemia and neurological symptoms were reversed in all patients after the procedure. During follow-up (median 24 months, range 6-60 months) all stent grafts remained patent and no aneurysm relapse was noticed. No signs of stent-graft infection were noticed in any of the patients and no reintervention was needed. CONCLUSIONS Primary endovascular exclusion of BAPs with a stent graft followed by surgical evacuation of pseudoaneurysm sac content is associated with good early and mid-term results in this limited experience. Larger patient cohorts are required for further evaluation of this technique.
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Affiliation(s)
- Chris Klonaris
- 1st Department of Surgery, Vascular Division, Athens University Medical School, Laiko Hospital, Athens, Greece
| | - Nikolaos Patelis
- 1st Department of Surgery, Vascular Division, Athens University Medical School, Laiko Hospital, Athens, Greece
| | - Mikes Doulaptsis
- 1st Department of Surgery, Vascular Division, Athens University Medical School, Laiko Hospital, Athens, Greece
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.
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False Arterial Aneurysm due to Long Bone Exostosis: Presentation of Two Cases and Update on Proper Management. Ann Vasc Surg 2015; 29:842.e19-22. [PMID: 25733214 DOI: 10.1016/j.avsg.2014.12.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 11/21/2022]
Abstract
Osteochondromas are the most common benign bone tumors. Vascular complications are unusual, with false arterial aneurysms being the majority among them. Although there are several reports of false aneurysms because of an exostosis in the femoro-popliteal region, cases presenting with a false aneurysm of the brachial artery are quite rare. Many suggestions have been made regarding prevention, diagnosis, and treatment of these false aneurysms, although there are no official guidelines. Therefore, this report aims to present 2 unusual cases of patients with a false aneurysm in the femoral and brachial artery, respectively, because of an exostosis. Literature data are discussed and useful conclusions regarding optimal management are made.
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