Acute limb ischaemia due to focal brachial artery aneurysms complicating brachiocephalic arteriovenous fistula ligation: two recent case reports.

INTRODUCTION: True brachial artery aneurysms are rare, typically occurring secondary to trauma. In this report, we describe two recent cases of patients who presented acutely with upper limb ischaemia due to brachial artery aneurysms. Both patients presented many years after brachiocephalic arteriovenous (AV) fistula ligation in the ipsilateral limb. REPORT: Two male patients, aged 60 and 63 years, respectively, were seen acutely with symptoms of upper limb ischaemia. They had both undergone ligation of AV fistulae many years earlier having received functioning transplants. Subsequently, both patients were found to have true brachial artery aneurysms, which were bypassed in both instances using great saphenous vein grafts. DISCUSSION: Patients undergoing ligation of AV fistulae should receive interval surveillance imaging to detect potential aneurysmal dilatation of upper limb vessels. Little is known about the incidence of aneurysm formation after AV fistula ligation; given the increasing number of patients undergoing dialysis, and hence the burgeoning number of patients who may receive transplants, it is important that upper limb ischaemia is pre-empted by appropriate follow-up.