Endovascular management of axillary artery trauma.

A 17-year-old man was seen with an expanding false aneurysm of the right axillary artery. This was treated by an intraluminal covered-stent introduced through the brachial artery via an 11F sheath. The covered-stent was constructed from a segment of great saphenous vein anchored in the axillary artery by a 29 mm Palmaz stent. Postoperative arteriography and duplex scanning confirmed normal flow through the axillary artery with complete exclusion of the aneurysm. Postoperative recovery was uneventful.     

真性腋动脉瘤切除及自体静脉移植腋动脉重建手术探讨

目的探讨切除真性腋动脉瘤并行血管重建的手术方法,总结瘤体游离和切除的操作体会。方法回顾分析1995年1月~2007年3月收治的14例真性腋动脉瘤患者,均行动脉瘤切除,自体静脉移植血管重建。结果病理诊断均证实真性动脉瘤,均获得临床治愈。平均随访5.5年(3个月~10年),1例术后2年出现吻合口狭窄,1例术后3年出现吻合口闭塞,1例术后5年死于急性脑出血,余11例无复发或并发症出现。结论真性腋动脉瘤切除、自体大隐静脉移植血管重建是一种可靠的治疗真性腋动脉瘤方法。     

Recurrent brachial artery embolism caused by a crutch-induced axillary artery aneurysm: report of a case

We report a case of axillary artery aneurysm with brachial artery embolism in a 60-year-old man who had walked with the assistance of axillary crutches all of his life since poliomyelitis during infancy had left him with lower limb paralysis. We performed bypass grafting from the axillary to brachial artery with exclusion of the aneurysm. An axillary artery aneurysm is rare, but potentially lethal for the upper extremity; therefore, surgical treatment should be considered.     

腋动脉真性动脉瘤的手术治疗

目的总结腋动脉真性动脉瘤的诊断和手术治疗体会。方法回顾分析1995年1月至2006年6月收治的16例腋动脉真性动脉瘤的临床资料,收集其病因、临床表现、辅助检查、手术中资料以及术后随访资料等。结果均表现为腋窝搏动性肿物,影像学检查均提示腋动脉瘤,均在全身麻醉下行动脉瘤切除,自体静脉移植腋动脉重建,结果均获得近期临床治愈。随访3~10年,平均5年5个月,1例术后2年出现吻合口狭窄,1例术后3年吻合口闭塞,1例手术后5年死于急性脑出血,余13例无复发或并发症出现。结论腋窝搏动性肿物是腋动脉真性动脉瘤的主要临床表现,无创性超声检查有助于明确诊断,真性动脉瘤切除、血管重建是一种可靠的理想的治疗方法。     

Endovascular treatment of ruptured axillary and large internal mammary artery aneurysms in a patient with Marfan syndrome

Marfan syndrome is an autosomally inherited disorder affecting the synthesis of connective tissues. Vascular manifestations of Marfan syndrome include aneurysmal dilatation of the aortic root, aortic dissection, and rupture. Peripheral aneurysms are mostly reported in the iliac, femoral, and subclavian arteries. We report a Marfan patient with a ruptured axillary artery aneurysm and a large left internal mammary artery aneurysm. The axillary aneurysm was successfully excluded using covered stent grafts, and the left internal mammary artery aneurysm was effectively coiled. Duplex ultrasound imaging at 4 months and computed tomography at 9 months demonstrated complete thrombosis and exclusion of both aneurysms with patent subclavian-axillary stent grafts.     

Axillary arteriovenous fistula after axillary plexus block

This report presents the case of a 51-year-old man who had an axillary arteriovenous fistula (AVF) as a complication of an axillary plexus block that was performed for internal fixation for a right forefinger phalanx fracture 4 years previously. While performing the axillary plexus block, a 22-gauge needle was placed inside the axillary sheath by observing the pulsations of the axillary artery. A pulsatile mass was found in the right axilla 1 day after the block was performed. Apart from this soft mass, the patient had no symptoms of vascular nerve damage. As the mass gradually increased in size, it became painful. During the past 3 months, in particular, the patient experienced repeated attacks of intermittent sharp pain and requested surgery. Digital subtraction angiography, performed 4 years after the axillary block, showed a tumor-like dilation was developing in both the right axillary artery and vein, almost simultaneously. Thus, the diagnosis of AVF was confirmed. The false aneurysm sac was excised and lateral repair of the axillary artery and vein was carried out under general anesthesia. Postoperative recovery was uneventful. The possible occurrence of an AVF after axillary plexus block should be kept in mind, because early diagnosis and treatment are necessary to avoid development of AVF and false aneurysm.     

Atherosclerotic axillary artery aneurysm

True aneurysms of the axillary artery are rare, most pulsatile masses in the region being pseudoaneurysms. The present study reports a case of a true atherosclerotic axillary artery aneurysm arising in a 65 year old lady which presented with a short history of a painless pulsatile mass and sensory defecit in the hand in the absence of limb trauma. Following preoperative imaging to determine the anatomic details, she underwent repair of the aneurysm and made an excellent symptomatic recovery.     

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.     

Endovascular management of isolated axillary artery aneurysm--a case report

The purpose of this paper is to report a case of axillary artery aneurysm, successfully treated by percutaneous transfemoral self-expandable polytetrafluoroethylene (PTFE) covered Wallgraft stent. A 20-year-old man presented with sudden-onset, severe aching pain of left upper limb that occurred while doing isometric exercise. He had feeble left brachial and radial pulses. Angiography revealed a 21 x 14 mm left axillary artery aneurysm with a 15 mm neck. There was an organized clot in the midpart of the left brachial artery. The aneurysm was successfully closed with a self-expandable 10 x 30 mm Wallgraft endoprosthesis PTFE graft stent, via the right femoral route. A check angiogram at 6 weeks of follow-up showed a patent stent with no endovascular leak. At 1 year of follow-up, the patient was asymptomatic with normal upper limbs pulsations. Axillary artery aneurysm may be treated with a stent graft, which is an effective, rapid, and definite treatment and is an acceptable alternative to standard open surgical repair.     

Spontaneous axillary artery aneurysm: a case report and review of the literature

Degenerative arterial aneurysms can occur in any vascular territory. However, they are exceedingly rare in the axillary artery. Complications of axillary artery aneurysms may result in acute vascular insufficiency and neurological deficits. Prompt treatment should be employed in the management of this condition. We report a case of an atraumatic degenerative axillary artery aneurysm that was treated with transaxillary open surgical bypass.     

INSUFFICIENT VENOUS DRAINAGE FOLLOWING AXILLARY APPROACH TO BRACHIAL PLEXUS BLOCKADE

Progressive obstruction of an axillary vein following an axillaryapproach to brachial plexus blockade is described. At surgicalexploration, the axillary vein was narrowed with an aneurysmof its wall. It is likely that, during the performance of theblock, the needle penetrated the adventitia of the vein, causinga sub-adventitial haematoma and an aneurysm of the vein wall.Normal venous drainage was re-established surgically and thepatient recovered completely     

Mycotic axillary artery aneurysm

Mycotic axillary aneurysms, not commonly encountered today, are generally the consequence of arterial trauma. A case of an axillary aneurysm secondary to a septic embolus from valvular vegetations in an intravenous drug abuser was studied. The case is reminiscent of those sporadically reported cases of the preantibiotic era. (J Vasc Surg 1998;28:708-9.)     

Transcutaneous axillary artery cannulation

The axillary artery may be an alternative cannulation site for patients with diffused atherosclerosis, aortic dissection, and aneurysm. There are different techniques for axillary artery cannulation that can be performed easily with a transcutaneous approach. Small incision necessity, less dissection, and good wound healing are other advantages of this technique.     

A case of abdominal aneurysm accompanied by an aneurysm of left subclavian artery

The case was a 62-year-old man. Two years ago under a diagnosis of aneurysm of the left subclavian artery he received: Ligation of aneurysm, aneurysmorrhaphy and extra anatomic bypass grafting from right axillary artery to left axillary artery. This time we palpated a pulsatile mass on his abdomen and performed replacement of abdominal aorta by Y shaped prosthesis following a diagnosis of abdominal aneurysm. In recent years population of advanced age have been increasing and arteriosclerotic diseases including aneurysm are also remarkably increasing. In the future we think that cases of multiple aneurysms such as this one will increase. In Japan we collected fifty cases of aneurysm of the subclavian artery including our case. In this paper we reviewed those cases and discussed the diagnosis and treatment of aneurysm of subclavian artery and multiple aneurysms.     

Hydrodynamic evaluation of axillary artery perfusion for normal and diseased aorta

Axillary artery perfusion is an attractive alternative to reduce the frequency of atheroembolism in extensive atherosclerotic aorta and aortic aneurysms. This study was conducted to evaluate the flow dynamics of axillary artery perfusion. Transparent glass models of a normal aortic arch and an aortic arch aneurysm were used to evaluate hydrodynamic properties. Streamline analysis and distribution of the shear stress was evaluated using a particle image velocity method. In the normal aortic arch model, rapid flow of 80 cm/s from the right axillary artery ran out from the brachiocephalic artery and grazed the lesser curvature of the aortic arch. There was secondary reversed flow in the ascending aorta. Flow from left axillary perfusion went straight to the descending aorta. In the aortic arch aneurysm model, flow from both axillary arteries hit the lesser curvature of the aortic arch and went into the ascending aorta with vortical flow. Distribution of shear stress was high along the jet from the ostium of the brachiocephalic artery and left subclavian artery. Flow in the aortic arch and the ascending aorta was unexpectedly rapid. Special care must be taken when the patient has frail atheroma around arch vessels or the lesser curvature of the aortic arch during axillary artery perfusion.     

白塞氏病导致动脉瘤的外科治疗

目的总结白塞氏病动脉瘤的外科治疗经验,并对其手术方式和药物治疗进行探讨。方法1977年4月～2004年12月收治的7例白塞氏病所致动脉瘤患者中,主动脉弓降部假性动脉瘤4例,右锁骨下动脉假性动脉瘤1例,右腋动脉假性动脉瘤1例,胸腹主动脉多发性假性动脉瘤1例。施行瘤体切除破口补片修补术4例,瘤体切除人工血管置换术1例,带膜支架腔内隔绝加左右腋动脉搭桥术1例,瘤体切除右锁骨下动脉结扎术1例。结果无住院死亡。术后吻合口动脉瘤形成1例,其它部位动脉瘤形成2例,股动脉插管后发生闭塞1例,移植物闭塞1例。随访1～12个月(平均5.7个月),死亡4例,其余3例存活。结论白塞氏病导致动脉瘤术后易发生吻合口动脉瘤和/或形成新的动脉瘤或动脉瘤破裂,根据病变部位的不同选择不同的处理方法,结合药物综合治疗可以取得较好的效果,其中人工血管置换术较补片修补术效果好。     

A safe option to perform an apparent difficult redo surgery

Abstract   A 50-year-old female operated of Bentall five years before was referred to our hospital for an aneurysm of both right subclavian artery and brachiocephalic trunk associated with a false anastomotic aneurysm on the insertion of the left coronary artery. The procedure was performed under moderate hypotermic circulatory arrest; the false aneurysm was repaired, the brachiocephalic trunk and the subclavian aneurysm were resected, an aorto-carotid and axillary bypass were finally performed. The postoperative course was uneventful. She was discharged to home on postoperative day 7. At six-month follow-up, she was still asymptomatic.     

Arterial complications caused by using an axillary crutch

BACKGROUND: Of all upper extremity emboli, up to twenty percent arise from an arterial, not a cardiac source. METHOD: We report about a patient with recurrent embolism, caused by an axillary crutch-induced aneurysm of the axillary artery. RESULT: After revascularisation by embolectomy and axillo-brachial vein graft bypass, the patient was free of symptoms. CONCLUSION: Angiography and duplex scanning were necessary for the correct diagnosis.     

Giant arteriosclerotic aneurysm of the axillary artery

A case of a rare giant arteriosclerotic aneurysm of the axillary artery is reported. Reconstruction was successfully performed with end-to-end anastomosis after resection of the aneurysm. The surgical technique is discussed.     

Axillary artery injury secondary to displaced proximal humeral fractures: a report of two cases

We report 2 cases of axillary artery injury secondary to low-energy proximal humeral fractures. In case 1, early diagnosis based on signs of acute ischaemia of the arm enabled early treatment and a favourable outcome. In case 2, there were no signs of ischaemia or neurological deficit, resulting in delayed diagnosis and increased severity of the injury. The patient developed a false aneurysm and sepsis and eventually died. A high index of suspicion is necessary for diagnosing an axillary artery injury. We recommend that all patients with proximal humeral fractures with severe medial displacement of the shaft and a bone spike should routinely undergo Doppler ultrasound scanning to rule out vascular injuries and the presence of a false aneurysm.