Pseudoaneurysm of brachial artery: A rare cause of median nerve compression

The authors present an unusual clinical case of high median nerve compression caused by an iatrogenic pseudoaneurysm of the brachial artery after an angiography with a follow up of 9 months.

A 73-year-old male was seen with progressive numbness, loss of opponency and diminution of strength of finger flexion in the left hand after an angiography with direct puncture of the left humeral artery. Physical examination revealed a hard consistency internal distal arm swelling with the size of a walnut, non-pulsatile and with a Tinel sign on percussion. Upper extremity arterial Doppler ultrasonography and magnetic resonance imaging didn't point to a pseudoaneurysm. Given the persistence and progressive worsening of symptoms, the patient was operated at 4 months after the beginning of symptoms through an anterior approach of the left elbow. The tumefaction corresponded to a brachial artery pseudoaneurysm completely thrombosed causing severe compression of the median nerve. Microsurgical neurolysis of the median nerve was performed and the pseudoaneurysm was removed.

At 9 months of follow-up the patient had total recovery of flexion of the thumb and forefinger and recovery of opposition with slight hypoesthesia on the volar surface of the radial fingers of the hand.

This case represents a rare form of high median nerve compression after angiography. The increased use of endovascular procedures may cause a higher frequency of these neurological injuries, and if confirmed, the patient should be operated as soon as possible to avoid serious neurological sequelae.