Thrombosis of a true brachial artery aneurysm after long term immunosuppressive therapy-etiology and implications

Abstract

Background True brachial artery aneurysms (BAAs) are rare compared to other peripheral artery aneurysms. These are usually associated with trauma, infections, and arteriovenous fistulas (AVF), but their association with other aneurysms is unclear. When symptomatic, patients with true BAAs often present with acute limb ischemia. In this report, we describe a case of a thrombosed BAA that was found in association with diffusely ectatic arteries and an aneurysmal para-renal and infra-renal aorta.Case report An 86-year-old male with a well-functioning deceased donor kidney transplant for more than 30 years presented with acute limb ischemia of the right upper extremity. He had a history of a ligated fistula of the right upper extremity several decades ago but had undergone no further access procedures. Initial duplex-imaging revealed an ectatic brachial artery (1 cm) and a 4.2 cm thrombosed BAA. He was taken to the operating room for an emergent exploration and brachial to ulnar artery bypass using reversed greater saphenous vein. He underwent a full body workup to look for other sites of aneurysmal degeneration which revealed a para-visceral aortic aneurysm and a large infra-renal aortic aneurysm.Conclusion We suggest that in patients who present with brachial artery aneurysms or diffusely ectactic vessels, it may be reasonable to obtain abdominal aorta duplex screening for aneurysmal disease, like what is done for patients with popliteal artery aneurysms.

Keywords

• True brachial artery aneurysm
• Arteriovenous fistula
• Abdominal aortic aneurysm
• Thrombosis
• Acute limb ischemia