Bilateral axillary artery aneurysms after Bentall procedure in Marfan syndrome

Extra-Thoracic Aneurysms in Marfan Syndrome: A Systematic Review of the Literature

INTRODUCTION

Marfan syndrome (MS) most often shows as thoracic aortic aneurysm (TAA) or aortic dissection, but it may also involve other vascular territories.

OBJECTIVE

To identify those extra-thoracic vascular manifestations most frequently associated with MS.

METHODOLOGY

Systematic review of the literature with PRISMA criteria. The following databases were included: Medline, Embase, Web of Science (WOS), Cumulative Index of Nursing and Health Sciences Literature (CINHAL); Spanish database MEDESY Cochrane Central Register of Controlled Trials (CENTRAL).

RESULTS

10,008 articles were identified, leaving 155 for the first stage of data analysis (total incidence of aneurysms) and 83 for the second (descriptive data analysis). Overall, 518 aneurysms were identified: 149 in the head and neck, 94 in the extremities 275 in the aortic, iliac and visceral sectors. Mostly, they were simultaneously discovered during studies of the AAT. In the abdominal aorta, the presentation with rupture in 11 of 32 patients stands out. Resection and bypass was the most frequently used method for repair in the treated cases.

CONCLUSIONS

Although its frequency in the general population is unknown, this systematic review suggests that extra-thoracic aneurysmal arterial involvement in the MS may be more frequent than expected. We believe screening for aneurysms in other vascular sectors may be advisable, especially in patients with MS and AAT.

Bilateral Aneurysms of the Axillary Arteries and Marfan's Syndrome

Aneurysms of the arteries of the upper limbs represent a rare pathology. Apart from the risk of rupture and according to their localization, they can be responsible for nervous or venous compression, for embolism and for ischemia. Axillary localization is particularly rare apart from an iatrogenic context. Open surgery and more recently endovascular techniques can be proposed, but real guidelines are lacking. We report the case of a patient presenting a Marfan syndrome and bilateral axillary aneurysms, with symptoms on the right side due to a nervous compression responsible for paresthesia. Aneurysms were treated in 2 stages by open surgery, starting on the symptomatic side.

Successful repair of a popliteal aneurysm with saphenous vein graft in a patient with Marfan syndrome

Marfan syndrome is an autosomal dominant disorder caused by mutations in the fibrillin 1 gene (FBN1). This leads to defective elasticity of connective tissue in the arterial wall. Aortic aneurysms and dissections are the most common vascular anomalies; the incidence of peripheral artery aneurysms is not well understood. Treatment options for infrainguinal disease are limited as endovascular interventions are generally contraindicated. The best conduit for arterial reconstruction is also unknown because there is concern that saphenous vein may become aneurysmal. Currently, there are few case reports regarding outcomes of infrainguinal arterial reconstructions, and follow-up has been very short term. We report a rare case of successful repair of a popliteal aneurysm using a saphenous vein graft in a patient with Marfan syndrome.

Surgical Treatment of a Left Axillary Arterial Aneurysm with Marfan Syndrome by Combining Two Skin Incisions

An axillary arterial aneurysm is a rare disorder, with few surgical cases reported to date. Here we report the case of a left axillary arterial aneurysm associated with Marfan syndrome. A 44-year-old female with Marfan syndrome presented with numbness of the left upper limb and a pulsatile mass on the left chest. A computed tomography scan revealed a highly enlarged and tortuous left axillary arterial aneurysm. We performed a graft replacement and resection of the aneurysm with two skin incisions. After the surgery, the blood flow to the patient’s left upper limb was confirmed, and the neurological symptoms improved significantly.