Case report, case study
https://doi.org/10.21860/medflum2022_275140
A rare case of median nerve intraneural hematoma after stenting of right iliac artery: a case report
Predrag Pavić
; University of Zagreb, School of Medicine, Zagreb, Croatia
Tomislav Meštrović
; University of Zagreb, School of Medicine, Zagreb, Croatia
Ivan Brižić
; University Hospital Center Zagreb - “Rebro”, Division for vascular surgery, Department of Surgery, Zagreb, Croatia
Majda Vrkić Kirhmajer
; University of Zagreb, School of Medicine, Zagreb, Croatia
Ana Marija Slišković
; University Hospital Center Zagreb, Division for angiology, Department of heart and blood vessel diseases, Zagreb, Croatia
Dražen Perkov
; University Hospital Center Zagreb, Division for endovascular radiology, Department of radiology, Zagreb, Croatia
Ivica Premužić Meštrović
; Clinical Hospital Merkur, Department of Cardiology, Zagreb, Croatia
Josip Figl
; University Hospital Center Zagreb - “Rebro”, Division for vascular surgery, Department of Surgery, Zagreb, Croatia
Andrea Crkvenac Gregorek
; University Hospital Center Zagreb - “Rebro”, Division for vascular surgery, Department of Surgery, Zagreb, Croatia
Abstract
Aim: Brachial artery access is an alternative approach to endovascular interventions when access to the femoral, radial, or ulnar arteries is not feasible, but it carries higher risk of periprocedural complications than other approaches, including median nerve injury. Nerve injuries can occur by direct puncture or by compression, with hematoma being the most common cause. Sometimes the compartment syndrome can accompany the direct nerve injury, masking the signs of a nerve dysfunction. Case report: We present a patient with a false aneurysm of brachial artery, surrounding soft tissue hematoma with volar arm and forearm compartment syndrome and a simultaneous median nerve intraneural hematoma caused by a direct punction. The combination of injuries occurred after brachial artery access for endovascular treatment of bilateral iliac artery steno-occlusive disease. The patient was successfully treated by fasciotomy, arterial sutures, and nerve decompression via paraneuriotomy. Conclusions: Intraneural hematoma caused by direct puncture can be masked by concomitant compartment syndrome. Emphasis should be put on prevention, early recognition, and timely surgical treatment of intraneural hematomas, especially those accompanied by fascial compartment syndrome after endovascular interventions.
Keywords
aneurysm, false; brachial artery; compartment syndromes; hematoma; median nerve
Hrčak ID:
275140
URI
Publication date:
1.6.2022.
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