Successful treatment of brachial artery aneurysm causing embolization after brachiocephalic arteriovenous fistula

Introduction: The brachial artery aneurysm is a rare condition that accounts for 5% of peripheral aneurysms. Most are pseudoaneurysms that develop as a result of iatrogenic exposure or trauma. True brachial aneurysm can develop after an occluded dialysis fistula. The causes leading to this development are unclear, but steroid-containing and immunosuppressive drugs used after kidney transplantation, as well as increased flow during fistula function and increased mechanical effects on the vessel wall, may play a role. The authors report the case of a 43-year-old patient who underwent two kidney transplants and was hospitalized for acute left arm ischemia. Imaging studies (angiography, CT angiography) confirmed left brachial aneurysm and dilatation of the thrombotic venous stem of the previous brachiocephalic arteriovenous (AV) fistula, and peripheral embolization. The patient was successfully treated in our hospital with the involvement of several subspecialties. The outflow pathway was opened by minimally invasive catheter thrombolysis, the source of embolism was eliminated by conventional vascular surgery, aneurysm ligation, resection of occluded dilated venous stem, and autologous venous saphenous bypass. By describing the case, the authors would like to draw attention to the complex mindset leading to successful treatment.