2019 Volume 28 Issue 5 Pages 361-365
True brachial artery aneurysm after long-standing arteriovenous fistula for hemodialysis are rare. We herein report a surgical case of true brachial artery aneurysm associated with vascular access. The patient was a 49-year-old man, who had been on dialysis for 35 years due to chronic renal insufficiency. His left antecubital arterio-venous fistula (AVF) became occluded after 20 years of use. A right antecubital AVF was created and the blood vessels of the left upper extremity had not been punctured in the 15 years since then. He visited a clinic due to numbness of his left hand. Cyanosis of the left hand and a pulsatile brachial mass were pointed out. Enhanced CT showed the left brachial artery was generally dilated and a giant aneurysm with dense intramural thrombus developed after the branching of the deep brachial artery. The numbness and cyanosis were suspected to be symptoms of embolization from the intramural thrombus. Aneurysmectomy and graft replacement with a reversed saphenous vein were performed. Pathological examination showed a true aneurysm.
