Iatrogenic pseudoaneurysms of the brachial artery are rare complications of haemodialysis access procedures and can lead to substantial morbidity and mortality if not managed promptly; however, surgery is also associated with the potential risk of severe complications. We describe the clinical and radiological findings relating to a dialysed patient who developed a huge iatrogenic pseudoaneurysm of the brachial artery (due to an inadvertent artery puncture), which was successfully treated by means of the percutaneous implantation of a polytetrafluoroethylene (PTFE)-covered stent.

Iatrogenic pseudoaneurysms of the brachial artery are relatively uncommon and generally caused by interventional vascular procedures,¹ and haemodialysis patients may experience the erroneous puncture of the brachial artery during venous cannulation.² This is a rare complication but can lead to adverse consequences such as rupture, infection, haemorrhage, distal arterial insufficiency, venous thrombosis and neuropathy. Furthermore, when treatment is delayed, enlargement of the pseudoaneurysm can lead to haemorrhaging, venous oedema of the extremity, cutaneous erosion and, particularly, adjacent neurological structure compression.³ Early diagnosis and appropriate treatment are very important because a pseudoaneurysm can lead to the loss of fingers or the entire upper extremity. Patients frequently experience painful swelling and numbness in the arm, and Doppler ultrasonography and angiography usually confirm the pseudoaneurysm accurately.^{4 5} Surgical vascular reconstitution is the traditional treatment for pseudoaneurysms but, as surgical interventions are associated with a risk of complications in dialysed patients, endovascular procedures provide an alternative and safe therapeutic option.⁶ However, as no data are available concerning the effectiveness of implanting a covered endovascular stent for the percutaneous closure of an iatrogenic brachial artery pseudoaneurysm in dialysed patients, we here describe successful endovascular treatment using a PTFE-covered stent in a haemodialysed patient.

At the 8-month follow-up visit, the patient was asymptomatic and Doppler ultrasonography revealed the occlusion of the pseudoaneurysm and the good patency of the covered stent.