Brachial pseudoaneurysm associated with median nerve injury as a complication of peripherally inserted central catheter: A case report (original) (raw)
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High Median Nerve Palsy Caused by Pseudoaneurysm After Brachial Catheterization: Two Case Reports
Journal of Medical Cases, 2017
We here present two very rare cases of high median nerve palsy caused by pseudoaneurysm after brachial catheterization. A 71-yearold woman developed high median nerve palsy 2 weeks after brachial catheterization. She underwent pseudoaneurysm resection together with neurolysis 4 months after the onset of palsy. Surgical findings suggested that her palsy was caused by both severe compression by pseudoaneurysm and adhesion following hematoma after catheterization. Five months after the surgery, she only had slight sensory disturbance. A 48-year-old lady developed high median nerve palsy 1 week after the catheterization. Simple pseudoaneurysm resection was performed 2 weeks after the catheterization. Neurolysis was not performed. Seven months after the surgery, she still had severe sensory disturbance. Our cases suggested importance of secured astriction after catheterization, and recommended surgical procedure for this condition is combination of pseudoaneurysm resection and neurolysis by hand surgeons.
Journal of Vascular Surgery, 2012
Objectives: Peripherally inserted central catheters (PICCs) may be complicated by upper extremity (UE) superficial (SVT) or deep venous thrombosis (DVT). The purpose of this study was to determine current PICC insertion patterns and if any PICC or patient characteristics were associated with venous thrombotic complications. Methods: All UE venous duplex scans during a 12-month period were reviewed, selecting patients with isolated SVT or DVT and PICCs placed <30 days. All UE PICC procedures during the same period were identified from an electronic medical record query. PICC-associated DVTs, categorized by insertion site, were compared with all first-time UE PICCs to determine the rate of UE DVT and isolated UE SVT. Technical and clinical variables in patients with PICC-associated UE DVT also were compared with 172 patients who received a PICC without developing DVT (univariable and multivariable analysis). Results: We identified 219 isolated UE SVTs and 154 UE DVTs, with 2056 first-time UE PICCs placed during the same period. A PICC was associated with 44 of 219 (20%) isolated UE SVTs and 54 of 154 UE DVTs (35%). The rates of PICC-associated symptomatic UE SVT were 1.9% for basilic, 7.2% for cephalic, and 0% for brachial vein PICCs. The rates of PICC-associated symptomatic UE DVT were 3.1% for basilic, 2.2% for brachial, and 0% for cephalic vein PICCs (2 P < .001). Univariate analysis of technical and patient variables demonstrated that larger PICC diameter, noncephalic insertion, smoking, concurrent malignancy, diabetes, and older age were associated with UE DVT (P < .05). Multivariable analysis showed larger catheter diameter and malignancy were the only variables associated with UE DVT (P < .05). Conclusions: The incidence of symptomatic PICC-associated UE DVT is low, but given the number of PICCs placed each year, they account for up to 35% of all diagnosed UE DVTs. Larger-diameter PICCs and malignancy increase the risk for DVT, and further studies are needed to evaluate the optimal vein of first choice for PICC insertion.
Working Paper of Public Health
Introduction: Peripherally inserted central catheters (PICCs) are catheters placed in the central venous system, through a peripheral vein. PICCs’ are devices designed for intermediate to long-term use, which are usually implanted for long periods and may be subjected to mechanical and infectious complications as well as thrombosis and acute bleeding during insertion or maintenance procedures. The aim of this study is to investigate and describe the various types of complications resulting from placement and management of PICC catheters in patients admitted to the SS Antonio e Biagio e Cesare Arrigo Hospital wards. Methods: Data was collected from the medical records of patients undergoing PICC implantation from June 2018 to December 2019.Results: Data from 320 patients were included in the study. 55% of patients did not develop complications. 34% of all patients with complications had minor complications and 86% of devices were not removed before the end of treatment.Conclusions: P...
Avoiding peripheral nerve injury in arterial interventions
Diagnostic and Interventional Radiology, 2019
A lthough peripheral nerve injuries secondary to angiography and endovascular interventions are uncommon and usually are not permanent, they can result in significant functional impairment. Most arteries used in access for angiography and endovascular therapies lie in close proximity to a nerve. The paired nerve may be injured by needle puncture, or by compression from hematoma, pseudoaneurysm, hemostasis devices, or manual pressure. Nerve injuries have been reported most frequently with axillary and brachial arterial access due to the anatomic proximity of the vessels and nerves at this location in combination with anatomic challenges for hemostasis. Given the higher rate of complications, axillary and brachial arterial access is typically reserved for situations where the interventionalist needs upper extremity arterial access, but the radial or ulnar arteries are not options due to anatomic or other factors. Subclavian arterial access is rarely used owing to high complication rates due to hemostasis challenges as it traverses the thoracic inlet (1). Femoral nerve injury, associated with common femoral artery access, is the second most frequently encountered. This is likely due to the high frequency of use of this access site in combination with the proximity of the femoral nerve just lateral to the common femoral artery in the femoral triangle. It has been suggested that nerve injuries related to angiography may be under-reported due to delayed onset of symptoms, their impermanent nature, lack of recognition, or reluctance of operators to report complications (2-5). Given the increasing frequency of endovascular arterial procedures and the increasing use of non-traditional access points, it is important that interventionalists have a working knowledge of peripheral nerve anatomy and function as it relates to arterial access sites. Upper limb Radial artery Radial artery access has gained popularity as a safe and technically useful technique, particularly for coronary, upper limb, mesenteric, renal, and neurovascular interventions since it has been associated with a lower incidence of major access site related complications compared to the traditional transfemoral approach (6-9). Although transient sensory impair-ABSTRACT Although peripheral nerve injuries secondary to angiography and endovascular interventions are uncommon and usually not permanent, they can result in significant functional impairment. Most arteries used in access for angiography and endovascular therapies lie in close proximity to a nerve. The nerve may be injured by needle puncture, or by compression from hematoma, pseudoaneurysm, hemostasis devices, or by manual compression with incidence in literature ranging from as low as 0.04% for femoral access in a large retrospective study to 9% for brachial and axillary access. Given the increasing frequency of endovascular arterial procedures and the increasing use of nontraditional access points, it is important that the interventionalist have a working knowledge of peripheral nerve anatomy and function as it relates to relevant arterial access sites to avoid injury. Diagnostic and Interventional Radiology Kuo et al. MCP, metacarpophalangeal; IP, interphalangeal; PIP, proximal IP; DIP, distal IP. *Branches of the anterior interosseous nerve. **Brachialis shares innervation from the radial and musculocutaneous nerves. Figure 3. Color doppler ultrasound image of the brachial artery (A), paired brachial veins (V), and median nerve (MN) above the elbow.
British Journal of Radiology, 2005
The objective of this study was to prospectively determine the incidence of venous thrombosis (VT) in the upper limbs in patients with peripherally inserted central catheters (PICC). We prospectively investigated the incidence of VT in the upper limbs of 26 patients who had PICC inserted. The inclusion criteria were all patients who had a PICC inserted, whilst the exclusion criterion was the inability to perform a venogram (allergies, previous contrast medium reaction and inability of gaining venous access). Both valved and non-valved catheters were evaluated. Prior to removal of the PICC, an upper limb venogram was performed. The number of segments involved with VT were determined. The duration of central venous catheterization was classified as; less than 6 days, between 6 days and 14 days and more than 14 days. VT was confirmed in 38.5% (10/26) of the patients. The majority 85.7% (12/14) were complete occlusive thrombi and the majority of VT only involved one segment. There was no statistical correlation between the site of insertion of the PICC and the location of VT. Neither was there any observed correlation between the occurrence of VT with the patient's history of hypertension, hypercholesterolaemia, coronary artery disease, diabetes mellitus, cardiac insufficiency, smoking or cancer. There was also no statistical correlation with the size of the catheter. In conclusion, PICCs are associated with a significant risk of upper extremity deep vein thrombosis (UEVT).
Fenestrated brachial vein perforated by the lateral root of median nerve: a case report
Anatomy (International Journal of Experimental and Clinical Anatomy), 2009
Variations of venous pattern in the arm are common. In this case report, we present a variation of brachial vein (BV) and lateral root of median nerve (LRMN). During routine educational dissections of axillary region, it was observed that a fenestrated BV was perforated by LRMN in the right arm of an old male cadaver. LRMN was not exposed to compression as it passed through the fenestration. It then joined the medial root of the median nerve to form the median nerve. The fenestrated segment of BV was narrow. However, BV coursed normally beyond this segment. There was no other anatomical variation in BV and LRMN both prior to the fenestrated segment and beyond it. Veins of the upper limb are commonly used for total parenteral nutrition, therapeutic invasive procedures, blood samples, blood transfusion, and catheterization and occasionally for grafting procedures. A large number of invasive procedures, both diagnostic and therapeutic are carried out using veins of the upper limb, particularly in and distal to the axillary region. Classic and variational anatomy of the upper limb is important with regards to surgical exposure of vessels in this region. Perforation of BV by the LRMN is a rare variation. Consequently, we think that it is important for the surgeons to keep this variation in mind in order to avoid possible complications such as nerve injury.
Incidence of Central Vein Stenosis and Occlusion Following Upper Extremity PICC and Port Placement
CardioVascular and Interventional Radiology, 2003
The purpose of this study was to determine the incidence of central vein stenosis and occlusion following upper extremity placement of peripherally inserted central venous catheters (PICCs) and venous ports. One hundred fifty-four patients who underwent venography of the ipsilateral central veins prior to initial and subsequent venous access device insertion were retrospectively identified. All follow-up venograms were interpreted at the time of catheter placement by one interventional radiologist over a 5-year period and compared to the findings on initial venography. For patients with central vein abnormalities, hospital and home infusion service records and radiology reports were reviewed to determine catheter dwell time and potential alternative etiologies of central vein stenosis or occlusion. The effect of catheter caliber and dwell time on development of central vein abnormalities was evaluated. Venography performed prior to initial catheter placement showed that 150 patients had normal central veins. Three patients had central vein stenosis, and one had central vein occlusion. Subsequent venograms (n ϭ 154) at the time of additional venous access device placement demonstrated 8 patients with occlusions and 10 with stenoses. Three of the 18 patients with abnormal follow-up venograms were found to have potential alternative causes of central vein abnormalities. Excluding these 3 patients and the 4 patients with abnormal initial venograms, a 7% incidence of central vein stenosis or occlusion was found in patients with prior indwelling catheters and normal initial venograms. Catheter caliber showed no effect on the subsequent development of central vein abnormalities. Patients who developed new or worsened central vein stenosis or occlusion had significantly (p ϭ 0.03) longer catheter dwell times than patients without central vein abnormalities. New central vein stenosis or occlusion occurred in 7% of patients following upper arm placement of venous access devices. Patients with longer catheter dwell time were more likely to develop central vein abnormalities. In order to preserve vascular access for dialysis fistulae and grafts and adhere to Dialysis Outcomes Quality Initiative guidelines, alternative venous access sites should be considered for patients with chronic renal insufficiency and end-stage renal disease.
Pseudoaneurysm of brachial artery: A rare cause of median nerve compression
Trauma case reports, 2018
The authors present an unusual clinical case of high median nerve compression caused by an iatrogenic pseudoaneurysm of the brachial artery after an angiography with a follow up of 9 months. A 73-year-old male was seen with progressive numbness, loss of opponency and diminution of strength of finger flexion in the left hand after an angiography with direct puncture of the left humeral artery. Physical examination revealed a hard consistency internal distal arm swelling with the size of a walnut, non-pulsatile and with a Tinel sign on percussion. Upper extremity arterial Doppler ultrasonography and magnetic resonance imaging didn't point to a pseudoaneurysm. Given the persistence and progressive worsening of symptoms, the patient was operated at 4 months after the beginning of symptoms through an anterior approach of the left elbow. The tumefaction corresponded to a brachial artery pseudoaneurysm completely thrombosed causing severe compression of the median nerve. Microsurgical ...