Complex regional pain syndrome type II secondary to endovascular aneurysm repair: a case report

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 emergent repair of the pseudoaneurysm. After repair of the pseudoaneurysm, the patient’s left upper extremity sequelae worsened. Four months after the repair, the patient demonstrated guarding of his left 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. 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, to our knowledge, one of the first reported cases of a complex regional pain syndrome induced by an EVAR procedure.