Mancini Andrea, Castriotta Giuseppe, Angelini Pernina, Bozzi Michele, Giancaspro Vincenzo, La Raia Elvira, Nisi Maria Teresa, Proscia Anna Rita, Tarantino Giuseppe, Vitale Ottavia, Cuzzola Cristoforo
S.C. di Nefrologia e Dialisi, Ospedale Di Venere, Bari, Italy.
S.C. di Chirurgia Vascolare, Ospedale Di Venere, Bari, Italy.
G Ital Nefrol. 2017 Jun;34(3):44-53.
A pseudoaneurysm or false aneurysm of the brachial artery is an uncommon occurrence in patients receiving hemodialysis with arteriovenous fistula (AVF). We describe the case of a 76-year-old woman presenting with a large, tender, pulsatile mass in the right antecubital region 10 cm from the AVF. B-mode ultrasound examination revealed a saccular hematoma. Color doppler showed a recirculation movement of blood, creating a two colors image called "Korean flag". The patient was transferred to the surgical unit where she first underwent ultrasound-guided compression and then surgical repair of the pseudoaneurysm. Two weeks after surgery the AVF was used again as an access for hemodialysis. Differentiating between a false and a true aneurysm based on ultrasound is not always straightforward. Doppler ultrasound findings can be decisive for the early diagnosis of a pseudoaneurysm to ensure proper treatment planning given the dangerous complications of ruptures. Treatment options include: compression, percutaneous thrombin injection, endovascular exclusion with covered stents, aneurysmectomy and surgical repair.
肱动脉假性动脉瘤或假性动脉瘤在接受动静脉内瘘（AVF）血液透析的患者中并不常见。我们描述了一例76岁女性患者，其右肘前区距动静脉内瘘10 cm处出现一个大的、触痛的搏动性肿块。B超检查显示为囊状血肿。彩色多普勒显示血液有再循环运动，形成一种称为“韩国国旗”的双色图像。患者被转至外科病房，首先接受超声引导下压迫，然后对假性动脉瘤进行手术修复。术后两周，动静脉内瘘再次用作血液透析通路。基于超声鉴别假性动脉瘤和真性动脉瘤并不总是那么容易。鉴于破裂的危险并发症，多普勒超声检查结果对于假性动脉瘤的早期诊断可能具有决定性意义，以确保制定适当的治疗方案。治疗选择包括：压迫、经皮注射凝血酶、带覆膜支架的血管腔内隔绝术、动脉瘤切除术和手术修复。
