From the Guidelines
The treatment for brachial artery pseudoaneurysm should prioritize endovascular techniques using covered stents, particularly in high-surgical-risk patients, as it offers a minimally invasive approach with a relatively high patency rate, as reported in a recent study 1. The primary goal of treatment is to prevent complications such as rupture, thromboembolism, or compression of adjacent structures, while also considering the patient's comorbidities and local expertise.
- Surgical repair, including resection of the pseudoaneurysm with end-to-end anastomosis or interposition grafting using autologous vein or synthetic material, may be considered for larger or symptomatic pseudoaneurysms.
- Ultrasound-guided compression therapy and ultrasound-guided thrombin injection are alternative minimally invasive options for smaller, asymptomatic pseudoaneurysms.
- Post-treatment, patients require close follow-up with serial ultrasound examinations to ensure resolution and detect any recurrence, as well as potential adjustment of antiplatelet or anticoagulant therapy 1. The choice of treatment depends on pseudoaneurysm size, location, and patient-specific factors, with the aim of optimizing outcomes in terms of morbidity, mortality, and quality of life.
- A recent study 1 reported an overall patency rate of 81.5% with a mean follow-up of 268.9 days for endovascular stent grafts, highlighting the potential benefits of this approach.
- However, it is essential to weigh the benefits and risks of each treatment option, considering the patient's individual circumstances and the potential for complications, such as graft infection or treatment failure 1.
From the Research
Treatment Options for Brachial Artery Pseudoaneurysm
The treatment for brachial artery pseudoaneurysm can vary depending on the size and location of the pseudoaneurysm, as well as the patient's overall health. Some of the treatment options include:
- Conventional surgical treatment, which includes aneurysm excision/opening and subsequent arterial reconstruction 2
- Endovascular repair with stent grafting, which has been reported to be effective in some cases 2, 3
- Ultrasound guided compression, which may be used for smaller pseudoaneurysms 4
- Percutaneous injection of thrombin, which can be used to treat pseudoaneurysms that are not suitable for surgical repair 4
- Endovascular covered stent exclusion, which can be used to exclude the pseudoaneurysm from the circulation 4
- Aneurysmectomy and surgical repair, which may be necessary for larger pseudoaneurysms or those that are causing symptoms 4, 5, 6
- Hybrid approach, which consists of primary endovascular aneurysm exclusion with a stent graft and subsequent open surgical evacuation of pseudoaneurysm content for decompression of adjacent structures 2
Surgical Treatment
Surgical treatment of brachial artery pseudoaneurysm typically involves aneurysm excision and arterial reconstruction. This can be done using a variety of techniques, including:
- Aneurysmal resection with saphenous vein graft interpositioning 5
- Surgical repair with fragment of the humerus removal 6
- Arterial reconstruction with different options depending on the extent of the arterial deficit 2
Endovascular Treatment
Endovascular treatment of brachial artery pseudoaneurysm involves the use of minimally invasive techniques to exclude the pseudoaneurysm from the circulation. This can be done using: