Bilateral Axillary Artery Aneurysms in a Six-Year-Old Child

Axillary artery aneurysms in pediatric patients: A narrative review

OBJECTIVES

Axillary artery aneurysms in children are rare and multifactorial. The presenting clinical picture can range from an incidental discovery to threatening symptoms, including loss of extremity function. With the present study we aim to give a comprehensive review of the existing literature focusing on the etiology and management of this rare but threatening pathology.

METHOD

A comprehensive review was made in a multi-staged manner. All identified studies have been categorized based on the type of lesions (true or false aneurysm) and their etiologies.

RESULTS

The treatments differ from the extension of the lesions and from the etiology.

CONCLUSIONS

Open surgery repair with great saphenous vein is still the best long-term approach, but even endovascular, embolization, or conservative management can be considered.

Axillary artery aneurysm in a construction worker, presentation of a rare case

INTRODUCTION AND IMPORTANCE

Axillary artery aneurysm is a rare anomaly in the vascular system of the upper extremity. Most of these aneurysms are false aneurysms and secondary to trauma. They can cause compressive symptoms as well as thromboembolic events leading to limb loss or even rupture as a life-threatening complication.

CASE PRESENTATION

A 33-year-old man came to the vascular clinic with the complaint of a pulsating mass in his axilla from 2 months ago. He had mild pain in his arm and the mass was palpable in his axillary fossa. It was pulsating and non-tender on touch. CT angiography revealed the aneurysm and the patient was treated surgically using reversed greater saphenous vein for replacing the aneurysmal segment of the artery.

CLINICAL DISCUSSION

Axillary artery aneurysms may be true or false. Duplex scan and CT angiography can reliably differentiate them from each other. When the diagnosis is confirmed, open and endovascular approaches can be used to treat these vascular anomalies.

CONCLUSION

When a patient has an axillary mass, axillary artery aneurysm is one of the differential diagnoses and any clinician should keep this entity in his mind when approaching axillary masses.

Management of upper extremity aneurysms: a systematic review

INTRODUCTION

The aim of this paper is to provide recommendations for diagnosis and management of arterial or venous aneurysms of the upper extremity.

EVIDENCE ACQUISITION

A systematic review of the Medline and Cockrane databases was performed from 1988 to 2019 by a combined strategy of MeSh terms.

EVIDENCE SYNTHESIS

One-hundred-forty-four publications were identified: 111 addressing arterial aneurysms and 33 addressing venous aneurysms. A total of 162 cases of arterial aneurysms, mostly brachial aneurysms (34.0% of cases) and 40 cases of venous aneurysms, mostly located in the forearm (60.0% of cases) were reported. For both types of aneurysms, most common presentation was the perception of a mass (56.3% for arterial one and 87.5% for venous one), but thromboembolic complication (46.7%), paresthesia (16.5%) or rupture (6.4%) could be observed in the setting of arterial aneurysms, while arm swelling (27.5%), neurological symptoms (12.5%), pulmonary embolism (10.0%) or rupture (2.5%) could occur in the setting of venous aneurysms. DUS was performed as first imaging modality for both settings, followed but CTA and MRA, especially in arterial aneurysms, to evaluate distal emboli and surrounding vasculature. Surgical treatment was mostly based on excision of the aneurysms with revascularization for arterial aneurysms (77.2%) and resection without reconstruction for the venous one (85.0%). Complications occurred in 10.5% of the cases of arterial aneurysms, none occurred after venous aneurysm resection.

CONCLUSIONS

Prompt diagnosis and appropriate preoperative imaging are mandatory in order to offer the best treatment modality. Open resection with revascularization seems to be the treatment of choice for arterial aneurysms, although endovascular procedures became more popular. Venous aneurysms require excision without revascularization.

Axillary Artery Aneurysm in a 3-Year-Old Child: A Rare Case and Review of the Literature

We report a rare case of 4 cm true aneurysm of left axillary artery in a 3-year-old girl. Computed tomography angiography confirmed the diagnosis. Open surgical repair with resection and primary end-to-end anastomosis was performed. The patient did not have any complication after 1-year follow-up. Axillary artery aneurysm is extremely rare in pediatric population. Previous reports of this rare entity are discussed comprehensively.