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Kidney Week

Abstract: FR-PO499

Brachial Artery Pseudoaneurysm (BAP): A Rare Cause of Median Nerve Neuropathy

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Truong, Huy, Riverside Community Hospital, Riverside, California, United States
  • Al-adroos, Hira H., Riverside Community Hospital, Riverside, California, United States
  • Ghyaz, Mohamed Zahan, Riverside Community Hospital, Riverside, California, United States
  • Dawoud, Dalia, Riverside Community Hospital, Riverside, California, United States
Introduction

BAP, a complication in long-term hemodialysis (HD) patients, often develops without symptoms but can rarely lead to median nerve neuropathy. Differentiating between causes of the neuropathy is crucial due to distinct treatment approaches, but it is challenging and can result in severe consequences. This case report aims to raise awareness of BAP as a possible diagnosis for HD patients with the neuropathy.

Case Description

A 53-year-old man with end-stage renal disease undergoing HD via a left brachiobasilic arteriovenous fistula (AVF) presents to the hospital with pain and weakness in his left first three fingers for three weeks. Patient had a history of difficulty with AVF cannulations, but his HD sessions were able to be completed fully. During a thrombectomy for AVF thrombosis outpatient, a brachial artery pseudoaneurysm was incidentally discovered through a retrograde arterial angiogram. The patient underwent surgical intervention, which relieved the pain but did not fully restore motor function due to prolonged compression of the median nerve.

Discussion

BAP warrants prompt recognition in patient’s presenting with median nerve neuropathy or pain at AVF sites. Symptoms may mimic other etiologies such as distal hypoperfusion ischemic syndrome. However, BAP can develop when there is arterial infiltration, especially in the patient whose AVF body overlaps with the feeding arteries. Therefore, it is crucial to educate dialysis staff not only on proper cannulation techniques but also on the mentioned anatomical variation. Additionally, physicians should consider arteriography to exclude the presence of arterial pseudoaneurysm in patients with progressing neuropathy, particularly those who have a history of difficulty with cannulation, to prevent prolonged nerve ischemia.

BAP in a retrograde arterial angiogram