Surgical treatment of deep brachial artery aneurysm

Deep brachial artery aneurysms are extremely rare. The purpose of this article is to report a case of deep brachial artery aneurysm that was successfully treated by open surgery. A 76-year-old man presented with complaints of an asymptomatic pulsatile mass in the left axilla. A computed tomography angiography revealed a deep brachial artery aneurysm. The aneurysm was resected surgically, then the axillary artery was repaired, and the distal end of the deep brachial artery was ligated without vascular reconstruction. The patient had a good recovery with no complications, and the arterial pulses of the left upper extremity were normal.     

Upper extremity aneurysm in infants.

We report a 2-month-old female infant with a false aneurysm of the brachial artery and an 8-month-old male infant with a true aneurysm of a common digital artery. These traumatic aneurysms in the upper extremity are extremely rare in infants. In the former infant, reanastomosis of the brachial artery was performed. In the latter infant, simple excision was successful.     

Innominate artery aneurysm: axial reconstruction via a cervical approach

True aneurysms of the innominate artery are rare. Successful axial reconstruction in the past has required a combined cervical and transthoracic approach with placement of a prosthetic graft. We describe herein the occurrence of an innominate artery aneurysm that extended to and involved the proximal common carotid artery and subclavian artery in a 63-year-old woman. The patient presented with thomboembolic sequelae in her fingertips and had a pulseless upper extremity. Successful aneurysmectomy and axial reconstruction with a bifurcated graft was achieved by using cervical exposure alone. A subsequent staged revascularization of the upper extremity was successfully accomplished with a brachial to radial artery bypass and ulnar artery transposition.     

Is There a Link between the Late Occurrence of a Brachial Artery Aneurysm and the Ligation of an Arteriovenous Fistula?

Arteriomegaly and aneurysms proximal to long‐standing posttraumatic arteriovenous fistulas (AVF) have been described. Much fewer are the reports of the late occurrence of brachial artery aneurysms following the closure of a hemodialysis AVF. Here, we report the case of a 55‐year‐old male patient. He had received a cadaver donor kidney transplant in 1996; his distal radiocephalic (RC) wrist AVF in the left arm had been ligated in 2001; he developed an aneurysm of the left brachial artery 9 years after the ligation of the AVF (2009). He underwent the surgical intervention of aneurysmectomy at the level of the left brachial artery with construction of a bypass with autologous saphenous vein. In conclusion, the development of a RC wrist AVF is an intrinsically dynamic process characterized by the increase in both blood flow rate and internal diameter of the brachial artery; the latter might be associated with enhanced fracture of the elastic fibers with the consequent risk of the development of an aneurysm. Thus, arteriomegaly and aneurysm of the brachial artery proximal to long‐standing AVFs might be seen as a “continuum” of these morphologic modifications.     

Axillary artery aneurysm associated with Arteriovenous malformations of the upper extremity: A case report

Introduction and importanceAxillary artery aneurysms are an uncommon upper extremity pathology. While trauma is the most common cause, degenerative aneurysms may occur in high-flow vascular conditions, such as upper extremity arteriovenous fistulas. Arteriovenous malformations (AVMs) are a rare cause.Case presentation and discussionWe herein describe a 41-year-old male with multiple congenital high-flow AVMs in the left upper extremity who presented with an asymptomatic axillary artery aneurysm. The aneurysm was successfully treated with open resection and revascularization using a reversed basilic vein interposition graft.ConclusionClinicians should be aware of the possibility of an axillary artery aneurysm in patients with upper extremity AVMs.     

Surgical treatment of distal ulnar artery aneurysm

In the past 7 years, we have encountered six patients with finger ischemia as a result of digital artery occlusion associated with seven distal ulnar artery aneurysms. Our experience with the management of these patients forms the basis of this report. All patients were men, with a mean age of 29 years, and all experienced repetitive trauma to the involved upper extremity. Each patient presented with the acute onset of cool and painful digits, with no previous history of cold sensitivity or Raynaud's syndrome. None of the patients had any serologic or clinical evidence of autoimmune disease. Angiography revealed occlusion of the ulnar artery on the affected side in two patients and patent ulnar artery aneurysms in the remaining five patients. There was occlusion of multiple common and proper digital arteries in all patients. One patient with bilateral ulnar artery aneurysms underwent operative repair consisting of aneurysm excision and replacement with autogenous vein grafts from the lower extremity. All patients have improved symptoms, and the grafts remained patent over a mean follow-up of 24 months (range: 13 to 57 months). Based on these results, we recommend that excision and grafting be considered for patients with symptomatic patent ulnar artery aneurysms. Selected patients with thrombosed aneurysms with ongoing digital ischemia may also benefit from surgical intervention.     

Axillary artery aneurysm as an occult source of emboli to the upper extremity

Reported here is a case of axillary artery aneurysm secondary to crutch trauma as a source of emboli to the upper extremity. This patient along with several reported in the literature was initially diagnosed and treated for brachial artery embolism. It is believed that awareness of this entity as a cause of forearm and hand ischemia is important in planning the appropriate surgical therapy.     

Infected upper extremity aneurysms: a review.

OBJECTIVES: To review the occurrence of mycotic aneurysm affecting upper extremity arteries. DESIGN: Literature review. MATERIALS AND METHODS: A MEDLINE search from 1950 until 2007 and an extensive manual search were carried out using bibliographies from relevant published papers including cases involving arteries distal to the subclavian. RESULTS: A total of 149 cases (68 papers) were identified. The brachial artery was the most frequently reported site, mostly associated with drug abuse, catheterization procedures or endocarditis. Since 1950 arterial trauma (drug abuse or catheterization) was the commonest cause. Gram positive organisms were the most frequent microbes involved. Acknowledging a limited follow-up, most patients did well when surgical therapy was promptly instituted. CONCLUSIONS: Infected upper extremity aneurysms have been rarely described. IV drug abusers are a unique high-risk group for mycotic aneurysms in the upper extremities, most importantly in the axillary and brachial arteries. When rapidly performed, arterial ligation, primary repair or reconstruction with autogenous conduits was associated with favorable outcomes.     

腋-腋动脉人工血管转流术在血管外科疾病53例中的应用

目的：探讨腋－腋动脉人工血管转流术在血管外科疾病中应用的价值。方法：回顾性分析，总结8年间行腋－腋动脉人工血管转流术的53例患者的临床资料。其中单侧锁骨下动脉闭塞46例；锁骨下动脉瘤3例，锁骨下动脉创伤4例，仅有肢体缺血症状的33例；同时伴有锁骨下动脉窃血症状的18例，2例真性动脉瘤患者无缺血和窃血症状。结果：53例患者术后上肢缺血及锁骨下动脉窃血症状消失，动脉瘤得以根治，患肢动脉搏动恢复正常，双侧肱动脉压力差均小于或等于10mm Hg，无任何手术并发症发生，治愈率为100％，39例得到术后随访，随访率为74％，平均随访时间3年3个月，所有转流人工血管均通畅良好。结论：腋－腋动脉人工血管转流术是一种方法简单易行，创伤小，风险低，并发症少，手术时间短，术后恢复快的术式，特别适合于有严重心脑血管疾病，年老，体弱或锁骨下动脉起始部难以显露，分离的患者。     

Dissecting aneurysm of the anterior cerebral artery requiring surgical treatment--case report

A 45-year-old male presented with spontaneous dissecting aneurysm in the anterior cerebral artery manifesting as headache persisting for several days and speech disturbance. Neurological and laboratory examinations showed no abnormalities. Magnetic resonance imaging revealed infarction in the right cingulate gyrus. Angiography revealed occlusion of the right A2. Repeat angiography 8 months later showed a saccular aneurysm had developed. The interhemispheric approach exposed the aneurysm at the junction between the right frontopolar artery and the pericallosal artery. The aneurysm was fusiform due to the right A2 dissection. The aneurysm was trapped and resected. One month after the operation, the patient was discharged without neurological deficits. Cases of dissecting aneurysms in the anterior cerebral artery with ischemic onset are usually treated conservatively. Cases requiring surgery include those due to trauma, growing aneurysms, giant aneurysms, and uncontrolled hypertension. Some dissecting aneurysms of the distal anterior cerebral artery require only resection without bypass surgery.     

Idiopathic true ulnar artery aneurysm

Introduction and importanceTrue ulnar artery aneurysms are a rare entity, with existing literature suggesting that most of these aneurysms are due to trauma. This case report sheds light on a true ulnar artery aneurysm that was deemed to be idiopathic.Case presentationA 49-year-old lady presented with numbness in the medial 3 fingers of the left hand, tenderness over the medial forearm, and a palpable ulnar artery pulse. There was no history of trauma. An arterial ultrasound, MRI of the forearm, and upper limb angiography confirmed the diagnosis of ulnar artery aneurysm. Surgical repair of the aneurysm was done with excellent immediate post-operative and follow up results.Clinical discussionTrauma is the most common cause for the development of ulnar artery aneurysms. In this case however, after detailed history taking, physical examination, and thorough investigations, the cause of the patient’s aneurysm was deemed to be idiopathic. Treatment of ulnar aneurysms are not well established due to the rarity of the disease. A surgical approach however may be considered depending on the location of the aneurysm along with the patient’s symptoms.ConclusionA high index of suspicion, thorough history, physical examination, and appropriate investigations are required to diagnose ulnar artery aneurysms. Surgical intervention is indicated to relieve symptoms of nerve compression and prevent limb threatening ischemia. Regular post-operative follow up is essential to detect potential graft dysfunction and to ensure a good outcome.     

Superior mesenteric artery branch aneurysm with absence of the celiac trunk

Superior mesenteric artery and pancreaticoduodenal artery aneurysms are rare. Agenesis of the celiac axis has only been reported four times. The reported etiologies of superior mesenteric artery and branch artery aneurysms include infection, atherosclerosis, inflammatory processes such as pancreatitis, dissection, collagen vascular disorders, polyarteritis nodosa, and trauma. We report an aneurysm of the superior mesenteric artery (SMA) branch, the inferior pancreaticoduodenal artery, arising in a patient with congenital absence of the celiac trunk. The patient presented with intermittent left upper quadrant pain without weight loss or change in bowel habits. The aneurysm was identified on abdominal computed tomography scan with angiographic confirmation of the aberrant anatomy. The patient was treated by aneurysmectomy and pancreaticoduodenal artery reconstruction with an interposition vein graft from the SMA. The patient recovered without complications and is asymptomatic with a patent vein graft 2 years after operation.     

Aneurysmatische Degeneration der A. brachialis nach Anlage einer Brescia-Ciminio-AV-Fistel zur chronischen Hämodialyse

Aneurysms of the upper extremity are rare. We present a case on isolated aneurysms of the brachial artery. A 45-year-old patient received an end–end fashioned Brescia-Cimino fistula (radial artery, cephalic vein) 13 years ago because of end-stage renal disease due to glomerulonephritis. The AV fistula thrombosed 4 months after successful kidney transplantation. The symptom of the aneurysms was compression of the ulnar nerve. The aneurysmatically altered brachial artery was resected and blood flow was reestablished by interpositioning reversed autologous saphenous vein. In our series of kidney transplant patients, this case is unique. The incidence of complications following aneurysms of the upper extremity is not known. Nevertheless, because of the severity of complications following these aneurysms, we recommend screening for them in patients who are in a chronic hemodialysis program during the performed duplex scan of the AV fistula.     

Posterior tibial artery aneurysm: A case report

Aneurysms of tibial vessels are extremely rare. The majority are pseudoaneurysms caused by trauma. Those that are true aneurysms have been associated with an inflammatory process or were mycotic in origin. We are reporting on a patient with a true posterior tibial artery aneurysm without any causative history. The aneurysm was repaired by resection and interposition of a reversed saphenous vein segment.     

Management of intra-abdominal aneurysms associated with periarteritis nodosa

Periarteritis nodosa is a disease of small and medium-sized arteries, frequently associated with multiple visceral artery aneurysms. Infrequently, these aneurysms rupture, usually with fatal results. A case of spontaneous rupture of a middle colic artery aneurysm in a patient with periarteritis nodosa is reported, and similar cases in the literature are reviewed. Treatment of a ruptured visceral artery aneurysm requires ligation or resection of the aneurysm without delay. Residual aneurysms are treated with cyclophosphamide and/or prednisone in an attempt to induce regression of the aneurysms. An arteriogram performed after 3 to 4 months of medical therapy determines the need for further surgical intervention.     

False aneurysm of the brachial artery complicating closed fracture of the humerus. A case report.

A 66-year-old, obese, mentally retarded man sustained a closed spiral fracture of the humerus accompanied by development of a large false aneurysm arising from a small rent in the distal third of the brachial artery. Because of the patient's body habitus, mental deficiency, and paucity of objective physical findings, the arterial injury was not suspected until expensive pressure necrosis necessitated shoulder disarticulation as a lifesaving measure. Although false aneurysms are known to complicate penetrating trauma and various surgical procedures using metallic implants, the lesion has not been previously reported with closed long bone fractures. The authors wish to alert others to occurrence of the occult arterial injury in association with a relatively common extremity fracture. The need to exercise special awareness and suspicion of subtle injuries in patients whose age, mental status, or associated trauma render communication of symptoms impossible, cannot be overemphasized.     

Aneurysm of a jejunal branch of the superior mesenteric artery in a patient with Marfan's syndrome

A case of post-traumatic aneurysm of a jejunal branch of the superior mesenteric artery in a patient with Marfan's syndrome is reported. Ascending aortic involvement is well known in Marfan's syndrome but no association with visceral artery aneurysms has been previously described. The blunt abdominal trauma preceding the detection of the aneurysm may have been the precipitating cause in a predisposed patient. Because of the high risk of rupture, aneurysms of the superior mesenteric artery branches should be treated. Excision or ligation without restoring continuity are the most common surgical procedures; endovascular embolization is an alternative option especially in high risk patients.     

Brachial artery aneurysm rupture in a patient with neurofibromatosis: a case report

Peripheral vascular manifestations of neurofibromatosis are rare but may result in fatal haemorrhaging when they rupture. Surgeons should be aware of this life-threatening condition. We report a case of 35-year-old woman with neurofibromatosis who presented with a swollen and tender mass around her right arm. Angiography revealed 2 aneurysms in the brachial artery. Surgical occlusion revealed a large amount of clotted blood within the subfascial space, and the bleeding point was identified as a pinpoint opening in the aneurysm. The brachial artery abutting the aneurysm and the surrounding soft tissues was extremely brittle and fragile, with massive oozing during dissection. The brachial artery was irreparable and was resected after ligation of the artery and surrounding soft tissues and the aneurysm. Despite an uneventful recovery, the patient died on day 4.     

A subclavian artery aneurysm associated with aortitis syndrome.

We performed surgery on a 61-year-old woman who had increasingly severe right shoulder pain and paresthesia in her right upper extremity as a result of a large right subclavian artery aneurysm. She had suffered from aortitis syndrome for 10 years for which she was treated with steroids and had multiple arterial lesions, including bilateral subclavian artery aneurysms, abdominal aortic aneurysm and obstruction of bilateral superficial femoral arteries. The right subclavian artery aneurysm measured 4 cm in diameter and rupture appeared imminent, prompting surgical therapy. Via the supraclavicular incision approach and additional partial sternotomy, the aneurysm was excluded and the brachiocephalic to right axillar arterial bypass was set up using an extended polytetrafluoroethylene graft. The patient recovered without complications and a subclavian artery aneurysm demonstrated by computed tomography was thrombosed 1 month after surgery. In conclusion, we recommend the exclusion technique to treat subclavian artery aneurysms in cases in which aneurysmectomy is likely to injure adjacent veins and nerves.