Presented at the 2013 AAPM Annual Meeting « Back

Complex Regional Pain Syndrome Type II Secondary to Endovascular Aneurysm Repair: A Case Report

Hamilton Chen, MD, hchen82@gmail.com¹, Amirpasha Ehsan, MD², Ronald Takemoto, MD³, (1) UCI Medical Center, Orange, California, (2) University of California-Irvine, Irvine, California, (3) VA Medical Center Long Beach, Long Beach, California

Introduction/Statement of the Problem: A 79-year-old male with an abdominal aortic aneurysm (AAA) status post endovascular aneurysm repair (EVAR) and left renal artery stent placement presented to our clinic with symptoms of atrophy and weakness of the left forearm and pain in the left hand. The EVAR procedure was performed two months prior. Upon examination, a pulsatile mass of 2-4cm was discovered in the left upper arm. Review of the operative report revealed that a catheter was introduced into the left brachial artery. An upper extremity ultrasound revealed a pseudoaneurysm of the left brachial artery. The patient was immediately taken for repair of the pseudoaneurysm. Results: After repair, the patient’s left upper extremity sequelae worsened. Four months after the repair, the patient demonstrated guarding of his hand and allodynia to the median nerve distribution. The patient had skin changes, contracture of his digits with significant weakness and atrophy. X-rays of the hand demonstrated osteopenia. A diagnosis of stage 3 complex regional pain syndrome type II was made. Conclusion: EVAR of abdominal aortic aneurysms is a recent advance in vascular surgery that has allowed repair of an AAA while offering reduced intensive care unit and hospital lengths of stay, reduced blood loss, fewer major complications, and more rapid recovery. Common complications from the procedure include: endoleak, migration, and structural failure. This is an extremely rare case of a chronic regional pain syndrome presentation induced by the formation of a pseudoaneurysm induced from an EVAR procedure.

Funding: None