The ulnar artery pseudoaneurysm

Median Nerve Palsy Caused by a Brachial Artery Pseudoaneurysm Following an Acute Penetrating Trauma

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.

Endovascular Management of Thenar-Hypothenar Aneurysms: Two Case Reports and Review of Literature

Thenar-hypothenar arterial aneurysms are rare, presenting as either true aneurysms or pseudoaneurysms. Traditionally, surgical repair has been the mainstay of treatment for these aneurysms, with only isolated cases of endovascular management reported. In this study, we describe two cases of thenar-hypothenar aneurysms successfully managed with coil embolization, accompanied by a brief literature review. Our findings suggest that endovascular management is a feasible treatment option for these rare aneurysms.

Delayed Formation of Traumatic Ulnar Artery Pseudoaneurysm Presenting With Ulnar Nerve Palsy: A Case Report

Ulnar artery pseudoaneurysm (UAP) is a rare occurrence after penetrating injury to the distal upper extremity and may lead to complications such as rupture, sensorimotor dysfunction, and compartment syndrome. We present the case of a 57-year-old man who developed delayed UAP after suffering a penetrating injury to the right forearm. UAP was diagnosed a week after the injury using CT angiography (CTA), which was indicated due to the onset of ulnar nerve palsy (mildly reduced hand-grip strength and fourth- and fifth-digit hypoesthesia and numbness) and growing swelling and tenderness of the right forearm. Due to concerns about UAP and hematoma formation, with resultant compression of the ulnar nerve and suspected hematoma infection, surgical intervention was performed wherein a moderate-size hematoma was evacuated and the ulnar artery was ligated. The decision to ligate rather than reconstruct was based on the suspected infected nature of the hematoma and adequate perfusion of the palmar arch by the radial artery. This case highlights the need for maintaining a strong index of suspicion for UAP after penetrating trauma to the distal upper extremity, due to the possibility of debilitating nerve deficits and compartment syndrome complicating late diagnosis. We also present an algorithm for the choice of management modality for UAP, which is a valuable addition to the existing literature.

Isolated Ulnar Artery Injury: Indications for and Timing of Operative Intervention

Background. Penetrating ulnar artery injury at the wrist is typically treated with immediate operative repair. This study reports a missed iatrogenic ulnar artery injury that resulted in the development of an ulnar artery pseudoaneurysm that was later managed with elective operative repair. The diagnosis and treatment of distal upper extremity pseudoaneurysms and the approach to suspected ulnar artery injury are discussed. Suspected isolated ulnar artery injuries without hard signs of bleeding can be managed with close follow-up and elective repair, should complications such as pseudoaneurysm occur.

Pediatric ulnar artery pseudoaneurysm of the wrist after glass laceration: A case report and systematic review of the literature

BACKGROUND

Our purpose was to explore a case of a complicated ulnar artery pseudoaneurysm and propose an algorithm to guide physicians in this scenario. We present a case of a 5-year-old boy with a pediatric ulnar artery pseudoaneurysm that developed after a wrist laceration from broken glass 6 weeks after the initial injury. The diagnosis of pseudoaneurysm was missed, and the patient was transferred to our facility in urgent need of resection and repair due to profuse bleeding. An ultrasound confirmed the suspected diagnosis of ulnar artery aneurysm with thrombosis within the vessel. An area of skin necrosis was also present. Upon exploration of the wound, the ulnar artery pseudoaneurysm was identified and resected. The defect measured six millimeters and it was repaired primarily, under the microscope, after the proximal and distal portions were freed by dissection. The patient's incision was well healed at six-week follow-up.

METHOD

A systematic literature review of the English literature on ulnar artery aneurysm was conducted on PubMed/Medline, Embase, Cochrane Clinical Answers, and Cochrane Clinical Trials, without timeframe limitations. Finally, we provide an algorithm to assist the decision-making process in similar scenarios.

CONCLUSION

Although ulnar artery aneurysm is rare on a pediatric patient, it should be considered in the differential diagnosis each time a patient presents with a wrist mass. In such cases, a high index of suspicion warrants examination by a hand specialist.

Posttraumatic pseudoaneurysm of a superficial branch of the ulnar artery: A case report

INTRODUCTION

Hand and Upper limb pseudoaneurysms are uncommon and misdiagnosed. The delayed diagnostic and treatment lead to severe vascular and nerve complications. Many mechanisms are involved like acute injury, chronic micro traumatism of the hand, with specific clinic and para clinic signs.

PRESENTATION OF CASE

The patient was a 30-years old woman, right-handed, admitted at the emergencies for a penetrating hand injury at the junction of the middle third - distal third of the left forearm, palmar surface, with a good radial and ulnar pulse, without sensory or motor deficit. No vessels injuries observed per operatively. A post-operative worsened pain opposite to the scar with a purplish pulsatile swelling appeared after 20 days of complete wound healing. A needle puncture with a red blood contain, motivated an US Doppler revealing a pseudoaneurysm of a superficial artery of the ulnar artery, surgically resected, without complication.

DISCUSSION

Two main mechanisms are involved in upper limb especially hand pseudoaneurysm: penetrating trauma and repeated micro traumatism. Superficial vessels are rarely damaged compare to deep subfascial vessels according to Laplace law. The diagnostic is clinical confirmed with the medical imaging. A pseudoaneurysm is suspected in front of a pulsatile painful tumefaction following a vessel path, with medical imaging in favor. A delayed misdiagnosis lead to a delayed care with severe complications as thrombosis, embolism and vessel. The therapeutic care is mainly surgical.

CONCLUSION

This case reports a delayed diagnostic of posttraumatic pseudoaneurysm of a superficial branch of the ulnar artery, managed with a surgical resection.