Leite Tulio, Pires Márcio, Pires Lucas, Chagas Carlos, Oliveira Antonio Claudio
Interventional Radiology Unit, Radiology Institute, Medical School, University of São Paulo, São Paulo, Brazil.
Hospital Universitário Antônio Pedro, Niterói, Rio de Janeiro, Brazil.
Int J Surg Case Rep. 2017;37:193-195. doi: 10.1016/j.ijscr.2017.06.044. Epub 2017 Jul 3.
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.
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.
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.
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.
假性动脉瘤是软组织出血引起的搏动性血肿。它是一种病因多样的罕见病症。我们报告一例由肱动脉医源性损伤导致的巨大假性动脉瘤病例。
一名42岁男性因右上肢肿胀及心肌梗死病史就诊于我院血管外科。患者在就诊前60天，由另一医疗团队进行了心脏导管插入术，由于导管放置在右肱动脉肘窝附近，我们怀疑是医源性假性动脉瘤，这一点通过其病史和体格检查得到证实。决定采用聚四氟乙烯假体植入治疗假性动脉瘤。未出现任何并发症，患者出院。
尽管肱动脉假性动脉瘤罕见，但假性动脉瘤在介入操作后比诊断性操作后更常见。假性动脉瘤的并发症可对患肢和患者生命造成严重威胁。任何假性动脉瘤的处理都取决于其大小、位置和发病机制。
假性动脉瘤发展缓慢，应尽早诊断以避免并发症并获得更好的治疗效果。由于近期血管内操作增加，且肱动脉穿刺更为常规，总体人群中肱动脉假性动脉瘤的发生率可能会上升。
