Brachial Artery Pseudoaneurysms Caused by Inadvertent Hemodialysis Access Needle Punctures  Annie Wang, MD, James E. Silberzweig, MD  American Journal of Kidney Diseases  Volume 53, Issue 2, Pages 351-354 (February 2009) DOI: 10.1053/j.ajkd.2008.08.008 Copyright © 2009 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Digital subtraction angiogram of the right upper-extremity fistula shows (A) aneurysmal dilatation at the arteriovenous anastomosis and (B) multiple small pseudoaneurysms (arrows) of the brachial artery and an enlarged right brachial vein. American Journal of Kidney Diseases 2009 53, 351-354DOI: (10.1053/j.ajkd.2008.08.008) Copyright © 2009 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 A 33-year-old woman with low access flow with a pulsatile mass in the distal forearm. (A) Transverse color Doppler sonogram image. The different colors within the pseudoaneurysm lumen indicate turbulent flow (different rates and directions of blood flow). (B) Digital subtraction angiogram shows a saccular pseudoaneurysm (arrow) of the left cephalic vein immediately central to the left radiocephalic anastomosis. Abbreviations: A, radial artery; V, cephalic vein. American Journal of Kidney Diseases 2009 53, 351-354DOI: (10.1053/j.ajkd.2008.08.008) Copyright © 2009 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 A 50-year-old woman status post surgical graft thrombectomy in the arm presents with a pulsatile mass in the forearm. Upper-extremity arteriogram shows a pseudoaneurysm of the anterior interosseous artery after surgical hemodialysis graft thrombectomy with use of a Fogarty catheter. Abbreviations: AI, anterior interosseous artery; B, brachial artery; R, radial artery; U, ulnar artery. (Reprinted with permission from Silberzweig et al.6) American Journal of Kidney Diseases 2009 53, 351-354DOI: (10.1053/j.ajkd.2008.08.008) Copyright © 2009 National Kidney Foundation, Inc. Terms and Conditions

Figure 4 A 67-year-old woman with a new pulsatile mass over her left arm hemodialysis access graft. (A) Hemodialysis graft pseudoaneurysm (arrow) was treated with (B) percutaneous placement of an endoluminal covered stent (arrows). Function of the existing graft was preserved and it could be used for hemodialysis access immediately after covered stent placement. American Journal of Kidney Diseases 2009 53, 351-354DOI: (10.1053/j.ajkd.2008.08.008) Copyright © 2009 National Kidney Foundation, Inc. Terms and Conditions