Ruptured brachial artery aneurysm in a patient with type 1 neurofibromatosis

Surgical Treatment of Multiple Venous and Arterial Aneurysms Due to Arteriovenous Malformations of the Arm

Introduction

Arteriovenous malformations (AVMs) are rare, especially in elderly patients. Occasionally, AVM can produce aneurysmal degenerations, which can lead to bleeding or rupture. The aim of this case report was to describe the surgical treatment of large arterial and venous aneurysms in the arm associated with an AVM.

Report

An 83 year old woman of White ethnicity who was a non-smoker presented with a large pulsatile aneurysm at the left elbow with paresis of the first three fingers. The diagnosis was made by duplex ultrasonography (DUS), computed tomography angiography (CTA), and arteriography. Additional tests confirmed aneurysms of the brachial artery and the outflow veins, with the largest more than 7 cm in diameter. A very proximal brachial artery bifurcation and increased venous flow were noted. DUS confirmed the AVM by showing continuous flow in the axillary vein. The decision for surgical resection involved vascular surgeons, radiologists, angiologists, and anaesthetists. Treatment involved opening and excision of multiple venous aneurysms and AVMs. A short segment of the aneurysmal brachial artery was also resected and repaired with end to end anastomosis. The deep brachial artery which supplied AVMs and venous aneurysms was ligated and excision of these lesions was performed. At one year follow up, there were no complications and the revascularisation was patent.

Discussion

Arterial and venous aneurysms occurring together with AVMs are rare and not well documented in the medical literature. In this case, surgical intervention, including resection with direct anastomosis of the arterial aneurysm coupled with excision of venous aneurysms and AVM, proved to be effective, as evidenced by stable post-operative outcomes after one year.

Successful revascularization using a saphenous vein for a ruptured brachial artery aneurysm in a patient with neurofibromatosis type I

Vasculopathy in patients with type 1 neurofibromatosis is known. Brachial artery aneurysms in patients with type 1 neurofibromatosis are rare, but any rupture can be extremely serious. A 56-year-old woman presented to our hospital with sudden pain in her right upper arm. Computed tomography revealed a ruptured brachial artery aneurysm, and operative reconstruction using a saphenous vein graft was performed. This is one of the few case reports of such successful revascularization using saphenous vein. The pathologic findings suggest neurogenic tumor invasion, and end-to-side anastomosis was effective in avoiding hemorrhagic complications.

Life-threatening brachial artery hemorrhage and a lethal outcome in patients with neurofibromatosis type 1: two case reports and a review of the literature

Neurofibromatosis type 1 (NF1) is an autosomal dominant disease characterized by neuorocutaneous lesions and multisystem involvement. Other notable features of NF1 include vasculopathy in the form of stenosis, occlusion, aneurysm, pseudoaneurysm, arteriovenous deformity, and rupture, which are difficult to manage and can have fatal outcomes. We describe two cases of extensive and progressive brachial artery hemorrhage following blunt trauma in patients with NF1. Management of these patients included combined endovascular and surgical treatment based on the patients' condition. The patients had a poor prognosis because of uncontrolled bleeding. While one patient died, the other survived, but the involved arm was amputated. Endovascular treatment is a widely used, popular, minimally invasive, and safe method to control the bleeding associated with NF1. However, this treatment can be challenging at times. Close collaboration between an interventional radiologist and surgeon is necessary for optimal treatment and careful follow-up for this condition.

A Case of Duodenal Neuroendocrine Tumor Accompanied by Gastrointestinal Stromal Tumors in Type 1 Neurofibromatosis Complicated by Life-Threatening Vascular Lesions

Patient: Female, 45-year-old

Final Diagnosis: Neuroendocrine tumor

Symptoms: Bleeding

Medication:—

Clinical Procedure: Pancreaticoduodenectomy

Specialty: General and Internal Medicine

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.

Successful Repair of a Vasculopathic Aneurysmal Brachial Artery in a Patient with Type 1 Neurofibromatosis

Vasculopathy is a well-recognized abnormality associated with neurofibromatosis type 1(NF1) and may cause stenoses, aneurysms, and arteriovenous malformations. We report a challenging case of a woman with NF1, who presented with spontaneous rupture of a brachial aneurysm around her right elbow, on a background of previous debulking and soft tissue reconstructive surgery in the same arm. She underwent successful delayed reconstruction of the brachial artery using an autologous great saphenous vein graft.

Successful Surgical Reconstruction of a Ruptured Brachial Artery Aneurysm in a Patient With Type 1 Neurofibromatosis

Introduction

The vascular pathology of patients with type 1 neurofibromatosis (NF-1) is known. Aneurysms of the brachial artery in NF-1 patients are rare and surgical treatment remains a challenge.

Report

A patient known to have NF-1 presented with swelling of the left arm. Computed tomography angiography showed a ruptured aneurysm of the brachial artery. Operative reconstruction was performed using reversed saphenous vein.

Discussion

Up to now four cases had been published describing brachial aneurysms in NF-1 patients. This case describes the successful reconstruction of a ruptured brachial aneurysm, using a saphenous vein.

A True Distal Brachial Artery Aneurysm Treated with a Bifurcated Saphenous Vein Graft

Brachial artery aneurysms are rare, mostly consisting of false ones secondary to infectious, traumatic, or iatrogenic arterial lesions. True aneurysms of the brachial artery are even more uncommon. Here, we report a case of a 40-year-old fisherman, without any pathological antecedent, who presented with a painful pulsatile mass of the left anterior arm. There was a slight edema with no ischemic signs. The computed tomographic angiography revealed a true 3.7 × 4.2 × 6 cm aneurysm of the distal brachial artery, partially thrombosed, which extended to the bifurcation. A surgical repair was indicated. Intervention consisted of an aneurysmectomy with interposition of an autologous reversed bifurcated saphenous vein graft. Early outcome was good and a 1-year follow-up showed a patent graft with no aneurysmal recurrence. A review of the literature on this rare location of true artery aneurysm and treatment options is outlined in this work.

Multiple aneurysms of the radial artery in a woman with neurofibromatosis type 1 presenting as aneurysm rupture

A 48-year-old woman with neurofibromatosis type 1 (NF1) experienced progressive forearm swelling coupled with impending compartment syndrome. Computed tomography angiography revealed a ruptured aneurysm of the proximal radial artery, multiple fusiform radial artery aneurysms, and a high independent ulnar artery origin. Compartment syndrome required prompt hematoma evacuation. Radial artery reconstruction, technically demanding due to vessel wall fragility, was deemed unnecessary because of satisfactory blood supply to the hand. Histologic findings indicated NF1-related vascular abnormalities also in the apparently normal radial artery as well as in a forearm vein, suggesting diffused vasculopathy. This case report is the first on ruptured radial artery aneurysm in NF1-related polianeurysmatic degeneration.

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.