There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
To delineate management strategies and outcomes for true aneurysms involving arteries
of the upper extremity distal to the axillary artery. The management of these rare
lesions has not been well established in the literature.
Retrospective chart review was performed at tertiary referral centers. All patients
who received the diagnosis of true upper extremity aneurysms distal to the axillary
artery between 1975 and 1995 were included in the review. Nineteen patients were found;
seven were excluded because no confirmatory diagnostic imaging study or operative
exploration was performed. This represents the largest reported series of true upper
extremity arterial aneurysms.
Twelve patients (9 men or boys) had 12 confirmed true aneurysms of the brachial or
more distal arteries. The average diameters were as follows: brachial artery 4.6 cm,
radial artery 2.0 cm, ulnar artery 1.4 cm, and digital artery 0.8 cm. The mean age
was 51 years (range, 10 to 86 years). The most common presentation was the presence
of a mass. This occurred among eight patients (67%). Four patients (33%) reported
pain or paresthesia. One patient (8%) had cold intolerance only. Three patients (25%)
had thromboembolic complications. Complications did not consistently correlate with
size or presence of intramural thrombus. Three aneurysms (25%) were initially managed
nonoperatively and followed for a mean period of 71 months. One of these required
operative repair after 5 months because of progressive pain. Ten patients (83%) were
treated surgically as follows: five underwent ligation and excision only, and five
underwent excision and revascularization. Morbidity was minimal, and there were no
perioperative deaths.
True arterial aneurysms of the upper extremity distal to the axillary artery are rare
and most commonly caused by blunt trauma. Fifty-eight percent of these lesions present
with symptoms or complications. Thirty-three percent of asymptomatic lesions later
become symptomatic. These factors combined with the minimal morbidity associated with
repair suggest that operative repair should be routinely performed for these aneurysms.
Revascularization can be performed selectively.