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Bautista-Sánchez J, Cuipal-Alcalde JD, Bellido-Yarlequé D, Rosadio-Portilla L, Gil-Cusirramos M. True Brachial Aneurysm in an Older Female Patient. A Case Report and Review of Literature. Ann Vasc Surg 2021; 78:378.e1-378.e8. [PMID: 34455052 DOI: 10.1016/j.avsg.2021.05.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Brachial artery aneurysms constitute 0.5% of peripheral aneurysms. These can be true or secondary to trauma or arteriovenous fistulas. These present as an asymptomatic pulsatile mass or may cause symptoms due to compression of adjacent neurological structures. CASE REPORT We present a review of the literature on clinical, histological, and therapeutic characteristics of true brachial aneurysms, motivated by the case of a 67-year-old woman with an asymptomatic pulsatile mass dependent on the brachial artery of the left arm who underwent open surgical correction with resection of the aneurysmal sac and interposition of great saphenous vein graft with adequate postoperative results.
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Affiliation(s)
| | | | | | - Luz Rosadio-Portilla
- Vascular Surgery Unit, Guillermo Almenara Irigoyen National Hospital, Lima, Perú.
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2
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Kuntz S, Lejay A, Georg Y, Thaveau F, Chakfé N. Management of upper extremity aneurysms: a systematic review. INT ANGIOL 2020; 39:161-170. [PMID: 32052949 DOI: 10.23736/s0392-9590.20.04307-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France - .,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France.,Department of Physiology, University Hospital of Strasbourg, Strasbourg, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
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Antonescu I, Knowles M, Wirtz E, Pascarella L. An Unusual Case of Bilateral Upper Extremity Ischemia Caused by Forearm Vessel Fibromuscular Dysplasia. Ann Vasc Surg 2018; 56:353.e7-353.e11. [PMID: 30500650 DOI: 10.1016/j.avsg.2018.08.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 11/19/2022]
Abstract
Fibromuscular dysplasia (FMD) is a nonatherosclerotic disease that generally affects medium-sized arteries. The distribution typically involves the renal, extracranial carotid/vertebral, and iliac arteries. FMD in other vascular beds is rare. We herein present the case of a 47-year-old female with rapid-onset bilateral digital ischemia. Initial differential diagnosis included vasospastic disorders and vasculitis. An upper extremity arteriogram was suggestive of ulnar and radial FMD. Percutaneous intervention was not successful, and the patient was managed conservatively with symptomatic improvement. This case highlights the important diagnostic and therapeutic considerations in patients with less common etiologies of upper extremity ischemia.
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Affiliation(s)
| | | | - Emily Wirtz
- UNC Division of Vascular Surgery, Chapel Hill, NC
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Kaneyuki D, Ueda H, Matsumiya G. Right Subclavian Artery Aneurysms with Fibromuscular Dysplasia. Ann Vasc Surg 2018; 48:253.e7-253.e9. [PMID: 29421412 DOI: 10.1016/j.avsg.2017.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/22/2017] [Accepted: 10/30/2017] [Indexed: 11/18/2022]
Abstract
Subclavian artery aneurysms (SAAs) are rare and even more uncommon in patients with fibromuscular dysplasia (FMD). A 20-year-old man with a past medical history of moyamoya disease presented with an abnormal mass shadow in the apex of the right lung on chest X-ray. Based on computed tomography imaging, a diagnosis of right SAA was established, and an excision of the aneurysm was performed. Because the left vertebral artery is dominant, the proximal and distal right subclavian artery and right vertebral artery were clamped. Then, the aneurysm was excised, and resection anastomosis was performed. Histological findings revealed FMD. The postsurgical course has been uneventful after 2 years. Among treatment modalities, open surgery would be the first choice for SAAs with FMD, despite the current era of endovascular surgeries.
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Affiliation(s)
- Daisuke Kaneyuki
- Department of Cardiovascular Surgery, Chiba University Hospital, Chuo-ku, Chiba-shi, Chiba, Japan.
| | - Hideki Ueda
- Department of Cardiovascular Surgery, Chiba University Hospital, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Hospital, Chuo-ku, Chiba-shi, Chiba, Japan
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Nguyen N, Sharma A, West JK, Serhal M, Brinza E, Gornik HL, Kim ES. Presentation, clinical features, and results of intervention in upper extremity fibromuscular dysplasia. J Vasc Surg 2017; 66:554-563. [DOI: 10.1016/j.jvs.2017.02.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
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Abstract
Fibromuscular dysplasia (FMD) is a noninflammatory, nonatherosclerotic disease of the vascular system, that can affect intima, media, or adventitia. The dysplasia in these layers leads to decrease in the lumen and increased turbulence leading to diminished flow through the affected portion. The treatment of FMD thus far has been either surgical and/or interventional. The authors describe a patient who presented with painful digits and who was found to have bilateral brachial artery FMD and was treated with balloon angioplasty with complete resolution of symptoms.
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Affiliation(s)
- Raghu Kolluri
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH
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Jones JL, de Silva U, Soh HC. Brachial artery aneurysm and thrombosis secondary to fibromuscular dysplasia. J Vasc Surg Cases Innov Tech 2016; 2:114-118. [PMID: 38827196 PMCID: PMC11140381 DOI: 10.1016/j.jvscit.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022] Open
Abstract
Fibromuscular dysplasia is a pathologic process causing stenosis and dilation of medium-caliber arteries of unknown etiology. It most commonly affects the renal and carotid arteries; however, it has been described in virtually all anatomic areas, including, rarely, the brachial artery. We describe a case of brachial artery aneurysm and thrombosis in a 29-year-old man secondary to fibromuscular dysplasia, treated surgically with excision, embolectomy, interposed vein graft, and anticoagulation.
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Affiliation(s)
- Julia Louise Jones
- Department of Surgery, Hornsby Kuring-Gai Hospital, Hornsby, NSW, Australia
| | - Upeksha de Silva
- Department of Surgery, Hornsby Kuring-Gai Hospital, Hornsby, NSW, Australia
| | - Hwei Choo Soh
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
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The interventional therapy for axillary stenosis with fibromuscular dysplasia of renal artery. Cardiovasc Interv Ther 2012; 28:184-7. [DOI: 10.1007/s12928-012-0139-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
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Margoles HR, Trerotola SO. Fibromuscular Dysplasia of the Brachial Artery Causing Hemodialysis Access Dysfunction. J Vasc Interv Radiol 2009; 20:1087-9. [DOI: 10.1016/j.jvir.2009.04.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 04/16/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022] Open
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10
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Shin JS, Han EM, Min BZ, Jung WJ, Jo WM, Lee IS. Fibromuscular Dysplasia of Bilateral Brachial Arteries Treated with Surgery and Consecutive Thrombolytic Therapy. Ann Vasc Surg 2007; 21:93-6. [PMID: 17349345 DOI: 10.1016/j.avsg.2006.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2005] [Revised: 03/06/2006] [Accepted: 03/06/2006] [Indexed: 11/20/2022]
Abstract
A 61-year-old female was admitted to our hospital complaining of paresthesia, pain, and intermittent weakness in the right hand. A pulsating mass with bruits had developed on the patient's upper arm. We also noted an absence of radial artery pulsation. The angiographic findings revealed a classic "string of beads" appearance, which involved both brachial and renal arteries. The right brachial artery exhibited an aneurysm, which was filled with thrombus, and the distal radial artery was occluded with thromboemboli. We excised the abnormal brachial artery segment, replacing it with an autogenous reversed saphenous vein conduit. Consecutive thrombolytic therapy was then performed for the treatment of the radial artery embolism. Histological examination revealed that the patient was suffering from medial fibromuscular dysplasia. This uncommon form of fibromuscular dysplasia, which involves both brachial arteries with embolization, can be efficiently treated via surgery and consecutive thrombolytic therapy.
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Affiliation(s)
- Jae Seung Shin
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, South Korea.
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Abstract
Fibromuscular dysplasia is a multifactorial arteriopathy that primarily affects small and medium-sized arteries. It is most common in the renal and internal carotid arteries. Pathological classification is based on the arterial wall layer most significantly involved. The natural history and incidence of asymptomatic disease is unknown. The most common lesions become symptomatic as a high-grade stenosis producing renovascular hypertension or as an embolic source for the cerebral circulation. Treatment is reserved for symptomatic lesions. Most simple lesions are effectively treated by catheter-based intervention. Surgical therapy is warranted for more complex lesions. Both produce durable, long-term results.
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Affiliation(s)
- Thomas K Curry
- Department of Surgery, University of California, San Fransisco 94143, USA
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Schunn CD, Sullivan TM. Brachial arteriomegaly and true aneurysmal degeneration: case report and literature review. Vasc Med 2002; 7:25-7. [PMID: 12083730 DOI: 10.1191/1358863x02vm411cr] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While brachial artery aneurysms are rare and usually of infectious, post-traumatic or iatrogenic etiology, true aneurysms of the brachial artery are even more unusual. We report on a large brachial artery aneurysm complicated by chronic contained rupture and partial outflow obstruction. This was observed 19 years after ligation of a radiocephalic (Brescia-Cimino) arteriovenous fistula for hemodialysis that had existed for 2 years. Of 581 brachial artery reconstructions performed at the Cleveland Clinic Foundation between January 1989 and December 2000, only three involved repairs of brachial artery aneurysms; only the reported case was a true aneurysm of degenerative origin for an incidence of 0.17% (1/581). The management of brachial artery aneurysms is described and the pertinent literature was reviewed.
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Affiliation(s)
- Christian D Schunn
- Department of Surgery, Robert C Byrd Health Sciences Center, West Virginia University, Morgantown 26506-9238, USA.
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Bonardelli S, Vettoretto N, Tiberio GA, Nodari F, Tardanico R, Giulini SM. Right subclavian artery aneurysms of fibrodysplastic origin: two case reports and review of literature. J Vasc Surg 2001; 33:174-7. [PMID: 11137939 DOI: 10.1067/mva.2001.110355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Right subclavian aneurysms involving the intrathoracic portion of the artery are rare and those of fibrodysplastic origin are mentioned in literature only as sporadic cases. In this article, we present two cases of this uncommon pathologic condition and discuss problems concerning diagnostic tools and technical choices. The two patients underwent a successful vascular graft substitution; an echo-Doppler scan revealed that they had no disease 1 and 2 years after the operation.
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Affiliation(s)
- S Bonardelli
- Department of General Surgery, University of Brescia, Italy.
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