PSEUDOANEURYSM IN THE ULNAR-INTEROSSEOUS ARTERY AS A RESULT OF A FIREARM WOUND. A CASE REPORT AND REVIEW OF THE LITERATURE

Introduction. Closed traumatic injuries and vascular accesses are the most common causation of pseudoaneurysms in peripheral arteries. The transformation of the socio-cultural characteristics of the population introduces new perspectives on this issue. Case report. We report the case of a 26-year-old male, who had a three-year history of clinical features characterised by tumour, pain in the cubital fossa of the left upper limb and distal paresthesias; the patient reported having suffered a previous firearm wound. Physical examination: a pulsating mass in the bend of the elbow, weak radial pulse and absence of ulnar pulse, diminished distal filling and temperature. Complementary tests: simple x-ray with no bone injuries, increased density of soft tissues and adjacent projectile. No magnetic resonance angiography was performed because of artefacts caused by the bullet. Doppler ultrasound: pseudoaneurysm of the distal brachial artery. Intravenous digital subtraction angiography: correct patency of the radial, brachial and subclavian arteries; pseudoaneurysm of the ulnar artery very close to its origin, with partial thrombosis; the interosseous artery derives from the ulnar artery, distally to the pseudoaneurysm, and the palmar arch is formed from the radial artery. Surgical intervention: proximal and distal ligation of the ulnar-interosseous trunk and resection of the pseudoaneurysm; the projectile was left untouched. Results. Radial pulse and distal capillary filling were correct with no motor deficit. In the control visit at 15 days, the wound was seen to have closed by first intention, radial pulse was present and digital paresthetic feeling had improved; the preoperative culture was negative. Conclusions. Surgical exclusion or repair of arterial pseudoaneurysms in accessible locations constitutes a feasible alternative, regardless of the aetiopathogenesis.