Management of upper extremity aneurysms: a systematic review

Surgical Treatment of True Arterial Aneurysms of the Hand: A Systematic Review

BACKGROUND

The present study evaluated the clinical features and safety of surgical strategies and treatments for true arterial aneurysms of the hand.

METHODS

A systematic search of the PubMed, Embase, Web of Science, Scopus, and CINAHL databases for clinical trials, case series, and case reports investigating true arterial aneurysms of the hand, published over the past 10 years, was performed. The inclusion criterion was surgical excision of arterial aneurysm, followed by arterial revascularization or ligation. Studies addressing pseudoaneurysms, mycotic aneurysms, conservative treatment, or no treatment were excluded. Summary level data regarding study characteristics and outcomes of amputation, neurological symptoms, number of preoperative vascular imaging examinations, and length of hospital stay were extracted.

RESULTS

Thirty-nine studies comprising 48 patients (mean [±standard deviation] age, 41.1 ± 22 years [range 0.5-80 years]; 39 [81.25%] male) were included. Thirty (62.5%) patients underwent only 1 preoperative examination and traumatic etiology was observed in 52.1% (n = 25). The most prevalent intervention was aneurysm excision, followed by arterial revascularization (n = 35 [72.9%]), with no amputations. Neurological symptoms were present in 8 (16.6%) subjects, with no difference between the revascularization and arterial ligation groups (odds ratio 3.36 [95% confidence interval 0.37-30.5]). The mean length of hospital stay was 1.44 days (range 0-4 days), with no difference between revascularization and arterial ligation (odds ratio 2.5 (95% confidence interval 0.10-62.6)).

CONCLUSIONS

This review did not find amputation rate outcomes associated with either technique, although similar neurological outcomes were observed. Nevertheless, the retrieved data were limited to those ensuring the safety of both procedures.

Surgical Treatment of a Giant Proximal Ulnar Artery Aneurysm Potentially Associated With Subacute Endocarditis

Ulnar artery aneurysms (UAAs), although infrequent, pose limited challenges in terms of timely diagnosis and surgical intervention. Their intricacy lies in discerning and addressing the underlying pathology, often necessitating prolonged hospitalization. Herein, we present a case detailing a giant aneurysm located in the proximal ulnar artery, measuring 5.2 cm in diameter. The patient exhibited negative microbial cultures and non-pathological transthoracic echocardiography (TTE). Successful treatment involved aneurysmal exclusion and saphenous vein graft interposition. While the initial microbiological cultures and TTE yielded negative results, the diagnosis of endocarditis was ultimately confirmed through a subsequent transesophageal echocardiography (TEE) examination. This case report underscores the imperative for heightened clinical suspicion when confronted with upper-limb aneurysms. The diagnostic process necessitates sustained diligence for identifying the underlying pathology, a task that, in certain instances, requires prolonged hospitalization. Both microbiological cultures and TTE have exhibited diminished sensitivity in the diagnosis of infective endocarditis and should consistently be complemented by TEE.

Hybrid Approach of a Complex Aneurysm of the Subclavian-Axillary-Brachial Axis: A Case Report

BACKGROUND

Upper extremity arterial aneurysms are a rare, potentially limb-threatening disorder. Due to its rarity, the best treatment modality and outcomes are not entirely established; however, there is a consensus that open surgery is the first-line treatment. We present a complex case of an arterial aneurysm of the subclavian-axillary-brachial axis adequately treated using a hybrid surgical and endovascular treatment.

CASE PRESENTATION

A 59-year-old man presented to the emergency department with acute ischemia of the right upper limb. An extensive thrombosed aneurysm of the subclavian-axillary-brachial axis was identified. The treatment was carried out in two stages. In the first phase, urgent limb revascularization was performed using the great saphenous vein to perform a subclavian-brachial artery bypass. Later, the aneurysm was excluded using a vascular plug and multiple coils. Successful treatment was achieved with no morbidity for the patient.

CONCLUSIONS

Although the gold standard for treating upper limb aneurysms is open surgery, endovascular techniques can be a significant adjunct, reducing treatment morbidity and even mortality.

True radial artery aneurysm in a patient with somatic mosaicism for a mutation in platelet-derived growth factor receptor β gene

We have presented the case of a right radial artery aneurysm (RAA) in a 27-year-old man with cerebral and coronary artery aneurysms and features of Parkes-Weber syndrome (port-wine stains and right upper extremity arteriovenous malformation and overgrowth). The RAA was repaired with an interposition great saphenous vein bypass graft. Analysis of the intracranial artery aneurysm and affected skin demonstrated a somatic mutation in the platelet-derived growth factor receptor-β gene. Mosaicism was present in the RAA but not in the great saphenous vein. Somatic mosaicism should be considered as a possible etiology for peripheral aneurysms in patients for whom standard genetic test results are unrevealing.