True Brachial Artery Aneurysm Following Blood Donation: A Case Report of a Rare Complication
Article Outline
Accidental arterial injury at time of blood donation is rare, but may lead to localized thrombosis and hematoma formation, and rarely, development of pseudo-aneurysm. We report the first case of true brachial artery aneurysm formation as complication of arterial injury from blood donation.
Keywords: True aneurysm, Brachial artery, Pseudoaneurysm, Transfusion
Introduction
Accidental arterial puncture is an extremely rare complication of blood donation. The commonest outcome of such injury is thrombosis and formation of localized haematoma. Rarer sequelae include arteriovenous fistula, false aneurysm development, and compartment syndrome. True brachial artery aneurysm following accidental arterial injury during blood donation has never been described. In the following case report, we present the case of true aneurysm formation as a consequence of arterial intrusion during blood donation.
Case Report
A 69-year-old patient was referred to the vascular clinic with a progressively increasing, painless swelling in the left antecubital fossa. The patient recounted that he had been a blood donor for every year since the age of 18. At his last blood donation, a phlebotomy nurse found difficulty in cannulating him, and took several attempts to draw blood. Following collection of blood, the patient noted a bruise around the puncture site, and two days later, a small swelling under the bruise appeared. Over time the swelling increased. Eight months from this injury, he presented to the clinic with this swelling and acute ischemia of the fourth digit of the left hand.
On examination, there was a 3
cm pulsatile, expansile swelling proximal to the flexion crease of the left elbow (Fig. 1). The other peripheral pulses were normal. The left ring finger showed signs of resolving ischaemia.
Fig. 1
3
cm smooth expansile and pulsatile mass seen medial and proximal to left elbow crease.
His comorbidity included a transient ischemic attack which occurred a year ago, and hypercholesterolemia. A carotid duplex scan showed minimal carotid bifurcation atheroma. His medications were clopidogrel and simvastatin. He was a non-smoker.
A duplex scan demonstrated a 2.1cm diameter fusiform true aneurysm of the brachial artery with mural thrombosis (Fig. 2). No evidence of arteriovenous fistulation was seen. Magnetic resonance angiography of the left upper limb showed a tortuous brachial artery, with a mild dilation at the site of the aneurysm.
Fig. 2
Duplex scan of left brachial artery revealing true fusiform aneurysm, with luminal thrombus attached in the near wall and covering almost half of the lumen.
The patient underwent elective exploration of the left antecubital fossa and repair aneurysm. An ‘S’- shaped incision was made over the antecubital fossa, and the brachial artery exposed (Fig. 3). Findings were a tortuous brachial artery with distal loop and a 2.5cm fusiform aneurysm just proximal to the bifurcation. On opening the aneurysmal sac, secondary atheromatous change was evident in the arterial wall with significant mural thrombus (Fig. 4). The aneurysm and loop were replaced with a saphenous vein graft.
Fig. 3
Brachial artery aneurysm exposed with tortuous proximal loop.
Fig. 4
Atheromatous change is evident after opening of the aneurysmal sac and evacuation of mural thrombus.
Post-operatively, the patient made an uneventful recovery. Histology of the specimen confirmed a fibrous-walled saccular true aneurysm (7mm diameter), with secondary atheromatous change. Features were non-specific, and all three layers of the arterial wall were intact.
Discussion
Serious complications of blood donation are rare. False aneurysm development following accidental arterial puncture is a rare event but has been well described in the literature.1 Over a 2-year period, Newman reported 12 cases of arterial puncture during blood donation from 410 000 blood donors.2 From these, 4 developed haematoma, and 1 developed a false aneurysm. In addition, the American Red Cross Blood Services report 4 cases of brachial artery false aneurysms from 9 million blood donations, over a period from 1999 to 2000.3
True brachial artery aneurysms are rare entities and occur either due to repetitive trauma or classified as idiopathic.4, 5 True brachial artery aneurysms as a result of accidental arterial puncture have not been described. We report what we believe to be the first report of a true brachial artery aneurysm developing after arterial puncture during blood donation. Although the patient had a clear timeline of disease progression, from recalling the event of highly probable arterial puncture with localized haematoma and appearance of a progressively increasing, pulsatile mass, and episode of distal embolism, likely due to the thromboembolic disease from the aneurysm, it is unclear whether the causative factor was single or repetitive trauma over his 51-year history of blood donation. Following surgery, the patient has been advised against venesection from the left antecubital fossa, but has not been dissuaded against further blood donation from the other arm, given the rarity of complications.
References
- . Pseudoaneurysm of the brachial artery: a rare complication of blood donation. Transfusion. 1994;34:253–254
- . Arterial puncture phlebotomy in whole-blood donors. Transfusion. 2001;41:1390–1392
- Serious donor reaction report. Chief operating officer letter COOL-089. Washington: American Red Cross Blood Services, November 9, 2000.
- . Management of true aneurysms distal to the axillary artery. J Vasc Surg. 1998;28:606–610
- . Brachial arteriomegaly and true aneurysmal degeneration: case report and literature review. Vasc Med. 2002;7:25–27
PII: S1533-3167(06)00092-6
doi:10.1016/j.ejvsextra.2006.10.007
© 2006 Published by Elsevier Inc.
Refers to article:
- True Brachial Artery Aneurysm Following Blood Donation: A Case Report of a Rare Complication , 30 December 2006
