We report a case of a patient who presented with an eight week history of a painful arm swelling, which initially occurred after insertion of a peripheral venous cannula. She had a history of atrial fibrillation for which she was anticoagulated with apixaban. On examination she had a pulsatile swelling, and Duplex ultrasound confirmed a brachial artery pseudoaneurysm. She underwent successful surgical repair. This is a known, albeit rare, potential complication of peripheral venous cannulation and was complicated in this instance by anticoagulation. We believe that this case highlights that even procedures as routine as cannulation are potentially dangerous. A good knowledge of local anatomy is essential to avoid complications such as this. In this case, the patient had to endure significant pain and uncertainty, followed by an operation and inpatient stay. If the pseudoaneurysm had ruptured it could have been catastrophic, particularly due to her anticoagulation. The main lesson of this case is to remember that cannula insertion is not entirely benign. Considering anatomy and ensuring the patient is appropriately consented are vital to avoid further situations such as this.
Frances Dixon, Maciej Juszczak, Tim Magee, Felicity Woodgate and Ashok Handa