Although a single small pseudoaneurysm AZD1390 that is located distal to the brachial bifurcation can be ligated [25], surgical excision with arterial reconstruction is the standard treatment. The arterial continuity should be restored with end-to-end anastomosis or a venous interposition graft [20, 27]. Endovascular stent-grafts implantation is a minimally invasive intervention with a high success rate. However,

the high cost of the device, luminal stenosis, and long-term complications, such as device failure, should be considered [28, 29]. Embolization of the sac is indicated when the sac is small and the pseudoaneurysm does not disturb the distal circulation. Embolization of the distal and proximal arterial segments is only indicated if collateral

circulation is sufficient [25]. US-guided compression was first introduced as a treatment of postangiographic femoral artery injury and also applied for treatment of a brachial artery pseudoaneurysm [30, 31]. However, there are limitations, such as a long procedural time, patient discomfort, and lower effectiveness with an anticoagulated patient. When there is infection, coexisting large hematomas with impending compartment syndrome, limb ischemia, skin ischemia, excessive patient discomfort, and unsuitable anatomy, US-guided compression is contraindicated [26]. Percutaneous thrombin injection is performed under US-guide and also conducted with the aid of intraluminal balloon occlusion [32, 33]. This has shown a high success rate and a low recurrence and complication rate. However, Selleck BLZ945 there have been several reports of complications, such as distal embolization, anaphylaxis, RANTES abscess formation, and pseudoaneurysm rupture. There can be complications including median nerve traction due to postoperative adhesion [24], true aneurysm formation [34] and Volkmann’s ischemic contracture [35]. This case did not show the generally observed symptoms of a pseudoaneurysm: swelling, thrill, and a mass-like see more lesion. A brachial artery

pseudoaneurysm was not suspected at first because the patient had visited the hospital with wound dehiscence, accompanied by oozing as the main complaint. It is difficult to perform an accurate physical examination after burn wound reconstruction because the surrounding tissue hardens as a result of fibrosis. This fibrosis of the surrounding tissues also helped to prevent continuous enlargement of the pseudoaneurysm in the present case. The pseudoaneurysm in this patient is likely to have formed gradually due to partial damage of the brachial artery wall during burn rehabilitation when the soft tissues adhered to the blood vessel tract, and due to burn-induced blood vessel injuries. As shown in Figure 4, the pseudoaneurysm originated from a slit-like opening of the brachial artery. And the surrounding neurovascular bundle sheath and muscles had fibrosis as a consequence of the severe burn injury.