Volume 48, Issue 4 December 2024 JVU 484-221 | Arterial Duplex Assessment of Brachial Artery Aneurysm Repaired with Resection and Reverse Saphenous Vein Graft Bypass-JVU 484-221 | Arterial Duplex Assessment of Brachial Artery Aneurysm Repaired with Resection and Reverse Saphenous Vein Graft Bypass

JVU 484-221 | Arterial Duplex Assessment of Brachial Artery Aneurysm Repaired with Resection and Reverse Saphenous Vein Graft Bypass

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The case report published in the Journal for Vascular Ultrasound details a rare instance of a brachial artery aneurysm in a 69-year-old male patient, following the ligation of an arteriovenous fistula (AVF). This medical condition is notably uncommon, accounting for only 0.17% of peripheral artery aneurysm cases. The patient's history includes a renal transplant and a brachiocephalic fistula creation, which went unused due to successful kidney function. However, years later, the patient developed a brachial artery aneurysm, believed to be a late complication of the AVF.<br /><br />The case emphasizes the critical role duplex Doppler ultrasound imaging played in the surgical assessment and planning. The duplex imaging revealed an aneurysmal dilation of the distal brachial artery, measuring 3.3 x 3.4 cm, with a tortuous structure and mural thrombus. Due to these findings and the aneurysm's position, open repair with resection and a reverse saphenous vein graft bypass was deemed the most appropriate treatment, avoiding the potential complications of stent placement in a highly mobile area.<br /><br />During surgery, the proximal and distal parts of the aneurysm were clamped, resected, and an anastomosis was performed with the saphenous vein. Post-procedure, multiplex Doppler waveforms confirmed pulsatile flow and no significant diameter reduction, indicating successful graft functionality. Additionally, a benign echogenic mass was observed, resolving six weeks post-operatively, affirming the success and safety of the procedure.<br /><br />This case underscores the importance of both meticulous surgical planning and close collaboration between the surgical team and imaging technologists. It highlights how duplex Doppler ultrasound not only serves as a diagnostic tool but also guides surgical interventions, especially in complex vascular cases. The report concludes with successful post-operative recovery, with no further vascular complications evident.

Keywords

brachial artery aneurysm

arteriovenous fistula

duplex Doppler ultrasound

vascular ultrasound

saphenous vein graft

aneurysm repair

vascular surgery

renal transplant

thrombus

vascular complications