At St Panteleimon Hospital of the First Medical Association of Lviv, vascular surgeons performed a complex operation on a 54-year-old patient from Ivano-Frankivsk region, removing a large pseudoaneurysm in the elbow crease area that had grown to almost the size of a grapefruit.
The patient, Oleksandra Vasyliv, has lived with chronic kidney failure for many years. Nineteen years ago, her kidneys completely failed and haemodialysis was started to cleanse her blood. To carry out the procedures, doctors created a fistula – an artificial connection between an artery and a vein that can withstand frequent needle punctures.
Later, the woman underwent a kidney transplant and the need for dialysis temporarily disappeared. However, she decided not to close the fistula, fearing possible rejection of the donor organ. Seven years later, the transplanted kidney did indeed stop working and the patient had to return to dialysis. By that time, a small pseudoaneurysm had already formed in the fistula area – a haematous formation that arose due to a microtear in the vessel wall.
Blood was leaking beyond the vessel, accumulating in a “sac” and then re-entering the general bloodstream, so the access continued to be used for procedures. As the woman lives in a village and is actively involved in household work, the arm with the fistula was constantly under strain and could be injured, causing the pseudoaneurysm to gradually enlarge. In time, doctors created a new fistula on the other arm, but the old formation remained.
According to the patient, for a long time it hardly bothered her, but this summer the pseudoaneurysm began to grow rapidly, causing severe pain and fear of possible complications. That was when she sought help from specialists in Lviv.
In Lviv, she was examined by the head of the vascular surgery department at St Panteleimon Hospital, Andriy Melen. The doctors found that there was still active blood flow inside the pseudoaneurysm, which made the formation pulsate almost in time with her heart and resemble a “second heart” on her arm. Because of its large size and the constant inflow of blood, there was a risk of massive bleeding in the event of rupture, so it was decided to operate.
The operation lasted about two hours. The vascular surgeons removed around 300 ml of blood from the pseudoaneurysm, ensured reliable haemostasis and restored the normal anatomical structures of the arm. According to Andriy Melen, such cases are rare, and this was the first such operation in their department this year.
Mrs Oleksandra is now feeling well, can use her arm fully and no longer has to hide it under her clothes.
The First Medical Association of Lviv provides a full range of modern medical care – from diagnostics and conservative treatment to complex surgical interventions, rehabilitation and prosthetics. It includes St Panteleimon, St Luke, St Nicholas and St Anna hospitals, the UNBROKEN rehabilitation centre and treatment and diagnostic centres.