A Case of Brachial Artery Thrombosis Caused by Massage of an Occluded Arteriovenous Graft

Background: Acute upper limb ischemia (AULI) is a potential complication associated with massages of occluded vascular accesses in patients undergoing hemodialysis. Pharmacological thrombolysis, endovascular intervention and surgical intervention are possible treatment options. Deciding the appropriate treatment strategy is still a controversial issue. Case Presentation: The patient was a 43-year-old woman with renal failure who underwent hemodialysis and peritoneal dialysis. She was found to have an arteriovenous graft (AVG) thrombosis at the start of a hemodialysis session. She underwent massage of the vascular access, and immediately after the massage, she reported pain and cyanosis in her right-hand fingers and was referred to our hospital. Duplex ultrasonography revealed a large number of thrombi in the brachial, radial and ulnar arteries. AULI due to brachial artery thrombosis was diagnosed and surgical intervention was performed on the same day. The vascular wall of the forearm artery was incised vertically against the running vessel and thrombi around the bifurcation of the radial and ulnar arteries were removed. Angiography guided-surgical intervention was performed and improvement in blood flow was achieved. The patient was discharged on the second day after the operation. Conclusion: Surgical intervention has been reported as an effective treatment of AULI due to brachial artery thrombosis after massage of an occluded vascular access.

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Atypical presentation of fistula dysfunction due to brachial arterial embolization mimicking stroke

The Journal of Vascular Access ◽

10.1177/11297298211067686 ◽

2022 ◽

pp. 112972982110676

Author(s):

Rita Vicente ◽

Laura Rodriguez ◽

Joaquim Vallespín ◽

Carolina Rubiella ◽

Jose Ibeas

Keyword(s):

Arteriovenous Fistula ◽

Doppler Ultrasound ◽

Vascular Access ◽

Brachial Artery ◽

Arterial Embolization ◽

Limb Ischemia ◽

Artery Occlusion ◽

Bedside Ultrasound ◽

Computed Tomographic ◽

Ultrasound Evaluation

Vascular access thrombosis is an important complication with great impact on access patency and, consequently, on a patient’s quality of life and survival. We report the case of a 73-year-old woman with chronic kidney disease on hemodialysis with a radiocephalic arteriovenous fistula on the right arm that was brought to the emergency department with decreased strength in her right arm, ipsilateral hypoesthesia and facial hemi-hypoesthesia. The patient was given a brain computed tomographic scan that did not confirm suspicion of stroke. On re-examination, the patient had new-onset pain at arteriovenous fistula level, and her right arm was cold and pale. The nephrology department was called for arteriovenous fistula evaluation. On physical examination, her forearm fistula had a decreased thrill and arm elevation exacerbated its paleness. A bedside ultrasound was performed for arteriovenous fistula assessment. Doppler ultrasound revealed: partial thrombosis at brachial bifurcation, a flow of 80–105 mL/min at brachial artery level and a radial artery with a damped waveform. Anastomosis and draining vein were permeable. In this case, the diagnosis of acute embolic brachial artery occlusion was made by a fast bedside ultrasound evaluation. The patient underwent thromboembolectomy with Fogarty technique, recovering fistula thrill, radial and cubital pulses. Thromboembolism of the fistula feeding artery is a rare cause of vascular access thrombosis and it is rarely mentioned in the literature. In this report, failure to recognize the upper limb ischemia would have led to delayed treatment, potentially resulting in the fistula’s complete thrombosis and further limb ischemia. We highlight the importance of a diagnosis method like Doppler ultrasound, which allows for rapid evaluation at the patient’s bedside.

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The forearm arteriovenous graft between the brachial artery and the brachial vein as a reliable dialysis vascular access for patients with inadequate superficial veins

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.10.101 ◽

2019 ◽

Vol 70 (1) ◽

pp. 199-207.e4

Author(s):

Giordano Fumagalli ◽

Fabio Trovato ◽

Massimiliano Migliori ◽

Vincenzo Panichi ◽

Stefano De Pietro

Keyword(s):

Vascular Access ◽

Brachial Artery ◽

Arteriovenous Graft ◽

Brachial Vein

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SP580THE ARTERIOVENOUS GRAFT BETWEEN THE BRACHIAL ARTERY AND VENA COMITANS: A RELIABLE VASCULAR ACCESS IN PATIENTS WITH INADEQUATE SUPERFICIAL VEINS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx153.sp580 ◽

2017 ◽

Vol 32 (suppl_3) ◽

pp. iii329-iii330

Author(s):

Giordano Fumagalli ◽

Stefano De Pietro ◽

Massimiliano Migliori ◽

Vincenzo Panichi

Keyword(s):

Vascular Access ◽

Brachial Artery ◽

Arteriovenous Graft

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A Case of Needle-Directed Pulse-Spray Pharmacomechanical Thrombolysis of Acute Brachial Artery Thrombosis

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-3401326 ◽

2019 ◽

Vol 03 (03) ◽

pp. 193-195

Author(s):

Yugandhar Samireddypalle ◽

Uma Maheshwara Reddy V. ◽

Chinmay Deepak ◽

Sankar Neelakantan ◽

Amitha Vikrama KS

Keyword(s):

Brachial Artery ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

First Line ◽

Management Options ◽

Artery Thrombosis ◽

Catheter Directed Thrombolysis ◽

Symptoms And Signs

AbstractAcute limb ischemia is a serious disabling condition. The management options depend upon the patient symptoms and signs of ischemia in the affected limb. The management options include surgical thrombo-embolectomy and catheter directed thrombolysis. Catheter directed thrombolysis has now become the first line of management in symptomatic cases. Here, we discuss a case of acute left brachial artery thrombosis which was successfully managed by needle-directed pulse-spray thrombolysis.

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Open surgery retrieval of a missing guidewire causing cerebral infarctions after cerebral angiography: a case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01531-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Chaodi Luo ◽

Jing Li ◽

Yang Yan ◽

Dan Han

Keyword(s):

Cerebral Angiography ◽

Open Surgery ◽

Foreign Bodies ◽

Treatment Options ◽

Case Presentation ◽

Appropriate Treatment ◽

Long Time ◽

Multiple Cerebral Infarctions ◽

Selection Of

Abstract Background Intra-aortic foreign body (IAFB) is uncommon, which is usually caused by a rupture of the catheter or guidewire. IAFB can cause catastrophic complications, including arrhythmia, embolization of guidewire fragments, intravascular clipping of the guidewire and vascular perforation. However, there are still no guidelines on removal and management of IAFB. Here, we present a rare case of fractured cerebral angiographic guidewires in the aorta that resulted in multiple cerebral infarctions. Case presentation A 50-year-old man experienced new cerebral infarction after cerebral angiography. Computed tomography and echocardiography demonstrated foreign bodies in his ascending aorta and aortic arch. Open surgery was successfully performed to retrieve the guidewires. The postoperation and follow-up was uneventful. Conclusion It is very important for interventional radiologists to check the catheter and guidewire after operation and perform ultrasound or radiograph to prevent IAFB. Additionally, the effective management of IAFB requires the early detection and the selection of appropriate treatment options, as well as long-time follow up.

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Acute Neonatal Upper Limb Ischemia: Topical Vasodilation, Anticoagulation and Physical Therapy-A new option for complete reversal of ischemia

Innovative Journal of Medical and Health Science ◽

10.15520/ijmhs.v11i06.3314 ◽

2021 ◽

Vol 11 (06) ◽

Author(s):

Harnarayan P ◽

Islam S ◽

Ramsingh C ◽

O' Donohue B ◽

Naraynsingh V

Keyword(s):

Physical Therapy ◽

Upper Limb ◽

Surgical Intervention ◽

Treatment Options ◽

Limb Ischemia ◽

Preterm Neonates ◽

Acute Limb Ischemia ◽

Complete Reversal ◽

Systemic Anticoagulation ◽

Neonatal Ischemia

Acute upper limb ischemia in neonates is extremely rare and oftenassociated with disastrous outcomes including digital gangrene, chroniclimb ischemia, sepsis and limb loss. It is usually seen in the contextof intra-arterial catheters in the preterm neonates but it can be alsoseen in cases of difficult or traumatic deliveries as well as in infantswith coagulation deficits but can also be spontaneous with no obviousaetiology. Treatment options include topical vasodilators, systemicanticoagulation and in some instances, surgical intervention. We reportthree cases of acute limb ischemia in preterm neonates in which anew treatment option was introduced. The neonates responded to acombination of topical nitro-glycerine cream, systemic anticoagulationwith heparin and physical light massaging of the area just proximalto the site of reduced flow in the vessel assuming some degree ofvasospasm of the vessel occurs with or without thrombosis.Keywords: neonatal ischemia, management of neonatal ischemia, topicalvasodilators, systemic anticoagulation, massage therapy, surgicalintervention

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Open Surgery Retrieval Of A Missing Guidewire Causing Cerebral Infarctions After Cerebral Angiography: A Case Report

10.21203/rs.3.rs-145158/v1 ◽

2021 ◽

Author(s):

Chaodi Luo ◽

Jing Li ◽

Yang Yan ◽

Dan Han

Keyword(s):

Cerebral Angiography ◽

Open Surgery ◽

Guide Wire ◽

Treatment Options ◽

Case Presentation ◽

Appropriate Treatment ◽

Long Time ◽

Multiple Cerebral Infarctions ◽

Selection Of

Abstract Background: Intra-aortic foreign body (IAFB) is uncommon, which is usually caused by a rupture of the catheter or guidewire. IAFB can cause catastrophic complications, including arrhythmia, embolization of guide wire fragments, intravascular clipping of the guide wire and vascular perforation. However, there are still no guidelines on removal and management of IAFB. Here, we present a rare case of fractured cerebral angiographic guidewires in the aorta that resulted in multiple cerebral infarctions.Case presentation: A 50-year-old man experienced new cerebral infarction after cerebral angiography. Computed tomography and echocardiography demonstrated foreign bodies in his ascending aorta and aortic arch. Open surgery was successfully performed to retrieve the guidewires. The postoperation and follow-up was uneventful.Conclusion: It is very important for interventional radiologists to check the catheter and guidewire after operation and perform ultrasound or radiograph to prevent IAFB. Additionally, the effective management of IAFB requires the early detection and the selection of appropriate treatment options, as well as long-time follow up.

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Evidence-based review of the surgical management of vertebral column metastatic disease

Neurosurgical FOCUS ◽

10.3171/foc.2003.15.5.11 ◽

2003 ◽

Vol 15 (5) ◽

pp. 1-10 ◽

Cited By ~ 42

Author(s):

Timothy C. Ryken ◽

Kurt M. Eichholz ◽

Peter C. Gerszten ◽

William C. Welch ◽

Ziya L. Gokaslan ◽

...

Keyword(s):

Metastatic Disease ◽

Vertebral Column ◽

English Language ◽

Surgical Intervention ◽

Treatment Options ◽

Standard Of Care ◽

Appropriate Treatment ◽

The Subject ◽

Guidelines And Recommendations

Object Significant controversy exists over the most appropriate treatment for patients with metastatic disease of the vertebral column. Treatment options include surgical intervention, radiotherapy, or a combination of the two; nevertheless, a standard of care that yields the best survival, outcome, and quality of life has not been established. The purpose of this review was to determine the foundation in the literature of views favoring surgical intervention for spinal metastatic disease. Methods A search of the English-language literature published between 1964 and 2003 was performed for the subject of spinal metastatic disease. Papers were selected based on the inclusion criteria described, and evidentiary information was compiled and graded using previously described methods. Conclusions Although there is insufficient evidence to support a standard for surgical treatment in patients with metastatic spinal disease, the authors present guidelines and recommendations based on the evidence provided by the current literature.

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Pseudoaneurysm of the brachial artey in two infants following accidental artertial puncture

VASA ◽

10.1024/0301-1526.34.3.198 ◽

2005 ◽

Vol 34 (3) ◽

pp. 198-200 ◽

Cited By ~ 1

Author(s):

Yilmaz ◽

Dogan ◽

Tok ◽

Hazirolan ◽

Guvener ◽

...

Keyword(s):

Blunt Trauma ◽

Vascular Access ◽

Brachial Artery ◽

Fibrous Tissue ◽

Arterial Puncture ◽

Artery Pseudoaneurysm

A pseudoaneurysm is defined as an aneurysmatic sac surrounded by fibrous tissue instead of other vascular layers such as the muscular one. It is a rare incident in infants especially in the brachial artery. Blunt trauma and vascular access attempts are the most common etiologic factors. We present two infants with brachial artery pseudoaneurysm in the antecubital region following accidental arterial puncture.

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