A Case of True Brachial Artery Aneurysm with Severe Left Upper Limb Ischemia

Abstract

Upper extremity aneurysms are relatively rare compared with other peripheral arterial aneurysms, and most are false aneurysms.1 Especially, true brachial artery (BA) aneurysms are rare. Although the majority of the BA aneurysms are thought to be the result of trauma, 2 their natural history and incidence are still unclear. Case ReportAlthough a 65-year-old man underwent the creation of a radiocephalic arteriovenous fistula at the left wrist in 2004 at another hospital, the fistula was occluded and so he underwent fistula creation at the right wrist in 2005. Moreover, he noticed a mass just above the left elbow joint that had slowly grown since 2010. However, he was referred to our hospital due to the mass measuring approximately 4 Â 4 cm with rest pain and slight ulceration of the left second and third fingers in 2015. He underwent hemodialysis three times a week and had a medical history of cerebral hemorrhage, type B aortic dissection, hypertension, atrial flutter, and chronic pancreatitis. The patient's height was 171 cm and body weight was 54 kg. The patient's blood pressure in the left upper arm was 122/79 mm Hg and pulse was 75/minute, while the pressure in the left forearm was not measured. Physical examination was unremarkable except for the mass just above the left elbow joint and left hemiplegia as well as no pulse of the left BA, radial, and ulnar arteries, respectively. Laboratory examination showed amylase, 198 IU/L; alkaline phosphatase, 583 IU/L; lactate dehydrogenase, 260 IU/L; total cholesterol, 266 mg/dL; blood urea nitrogen, 47.8 mg/dL; creatinine, 8.23 mg/dL, prothrombin time and international normalized ratio, 1.63, and C-reactive protein, 3.80 mg/dL. Ultrasound showed a left upper limb thrombosed mass just above the left elbow joint. Enhanced computed tomography revealed the left patent proximal BA and ulnar artery as well as the fusiform thrombosed mass measuring 3 Â 3 cm at the distal BA (►Fig. 1A-C). Cardiac ultrasound showed an almost normal left ventricular function (ejection fraction: 52%) and mild aortic regurgitation. Thus, we diagnosed him with a left BA aneurysm with severe upper limb ischemia. In a supine position, after we harvested the left great saphenous vein (GSV) of a medial thigh, the proximal and distal BAs were exposed (►Fig. 2). As the distal BA mostly showed a calcified intima, excision of the aneurysm and BA replacement were performed with a GSV graft after endarterectomy at the distal anastomosis. The wall of the fusiform aneurysm measuring 3.4 Â 2.0 cm was solid without adhesion around the tissues (►Fig. 3A). Keywords► upper limb ischemia ► true brachial artery aneurysm ► arteriovenous fistula AbstractBrachial artery (BA) aneurysms are rare, and most are false aneurysms. Although true BA aneurysms have been reported, most have been reported without symptoms. A 65-yearold man was referred due to a left upper limb mass with rest pain and slight ulceration of the left second and third fingers. As enhanced computed tomography revealed the patency of only the left proxi...

True brachial artery aneurysm after arteriovenous fistula closure following renal transplantation: a case report and literature review

“…The pathological examination did not reveal typical arteriosclerotic change, but CT findings showed the severe arteriosclerotic change in the abdominal aorta, so it was very likely that the brachial artery got some arteriosclerotic effect and damaged. And more, Marconi et al [13] and Nishimura et al [14] reported true BAA located near the elbow like our case. Chronic mechanical stimulation, an elbow joint movement might also promote damages to the brachial artery.…”

Acute right upper extremity ischemia resulting from true aneurysmof right brachial artery: A case report

“…Rest pain and ulceration usually respond dramatically to revascularization. 10 However, recurrence of brachial artery aneurysm has also been reported. 11 Our case also responded considerably to treatment and the postoperative course was uneventful.…”