title: Acute limb ischaemia due to focal brachial artery aneurysms complicating brachiocephalic arteriovenous fistula ligation: two recent case reports.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 St George's Vascular Institute, London - UK.
authors.forename: Sandeep S
authors.initials: SS
authors.lastname: Bahia
authors.forename: Francesca
authors.initials: F
authors.lastname: Tomei
authors.forename: Baris A
authors.initials: BA
authors.lastname: Ozdemir
authors.forename: Eric S
authors.initials: ES
authors.lastname: Chemla
mesh_terms: D000783:Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation; D008026:Ligation; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*