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Case Reports in Vascular Medicine
Volume 2015 (2015), Article ID 236193, 3 pages
http://dx.doi.org/10.1155/2015/236193
Case Report

A Perplexing Presentation of Entrapment of the Brachial Artery

1Kartal Kosuyolu Education and Research Hospital, Department of Cardiovascular Surgery, 34862 Istanbul, Turkey
2American Hospital, Department of Cardiovascular Surgery, 34365 Istanbul, Turkey

Received 11 April 2015; Revised 1 June 2015; Accepted 2 June 2015

Academic Editor: Po-Hsun Huang

Copyright © 2015 Deniz Cevirme et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 45-year-old male being otherwise healthy presented acute onset of right upper extremity ischemia. On physical examination, axillary artery could be palpated whereas the brachial artery could not be palpated below the level of the antecubital fossa, including radial and ulnar artery pulses. Pulses were also inaudible with pocket-ultrasound below the level of the brachial artery bifurcation. The patient was initially diagnosed to have acute thromboembolic occlusion and given 5000 IU intravenous heparin. The patient was taken to the operating room. We noticed that the ischemic symptoms disappeared within a couple of minutes just before we began the operation. However, ischemic symptoms reappeared six hours later and computed tomography angiography showed lack of enhancement below the elbow crease. We were taking the patient to the operating room for the second time when the symptoms recovered in a few minutes, again. The operation was not canceled anymore. In the operation, the brachial artery was found anomalously perforating and it was entrapped by the bicipital aponeurosis. The artery was relieved by resecting the aponeurosis and there was no need for any other intervention. The patient had no more recurrence of symptoms postoperatively.