Venous Pseudoaneurysm in a Dialysis Patient. Case Report and Review of the Literature

In the operating room, the hypertrophied right brachiocephalic fistula and brachial artery was controlled above and below the AVF. The fistula was transected and oversewn with 3-0 Prolene suture, the venous side was then oversewn with 5-0 Prolene suture. A micropuncture needle was then placed into the fistula stump through which a wire was advanced and a 5 F sheath was placed. A venogram revealed a hypertrophied and tortuous cephalic vein, but no arterialized flow. The catheter was advanced and venography of the innominate vein and superior vena cava was performed revealing aneurysmal internal mammary vein (IMV). The origin of the IMV was selected, and the wire was advanced into the inferior epigastric vein. A 9 F sheath was positioned over the wire into the aneurysm sac and an Amplatzer plug was deployed in the neck and central venous portion of the aneurysm. Venogram demonstrated the plug to be in good position. Repeat venography with the catheter in the cephalic vein revealed no residual flow in the pseudoaneurysm. All devices were removed and the cephalic vein was repaired directly with 5-0 Prolene suture. Skin was closed and a compression dressing was placed.


By postoperative day two, the patient reported significant improvement in the tension in his right arm and had regained range of motion at the right wrist, hand, and fingers. He was discharged, and followed up in the office.


Conclusions:

The patient was treated with an Amplatzer plug with resolution of flow in the PSA, and greatly improved arm swelling. Long term follow up was not possible, as the patient died of unknown causes.