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A 50-year-old woman was admitted to our clinic with a swollen and pulsatile mass in her right upper extremity. On physical examination, a pulsatile mass, approximately 40 mm in diameter, was palpated in the vicinity of the right brachial artery. The right and left upper-extremity pulses were both palpable, and equally so. The patient had no relevant history of trauma. Selective upper-extremity angiography revealed a right brachial artery aneurysm 40 × 25 mm in size (Fig. 1). Transthoracic echocardiography yielded normal results, as did duplex ultrasonographic examination of the abdominal aorta and the lower-extremity arterial systems.
The patient underwent axillary brachial plexus block anesthesia and surgical treatment. Intraoperatively, we found a saccular aneurysm originating from the right brachial artery (Fig. 2). The aneurysm was resected (Fig. 3), and the lesion was bypassed with a saphenous vein graft to the right brachial artery (Fig. 4). Postoperatively, the right-extremity pulse was palpable. The patient was discharged without sequelae. Histopathologic examination of the resected aneurysm revealed medial degeneration, fibrosis, and disruption of the elastic laminae (Fig. 5).
Upper-extremity peripheral artery aneurysms are rarely encountered.1 While all brachial artery aneurysms are rare, most are dissecting aneurysms of infectious, post-traumatic, or iatrogenic origin; true aneurysms of the brachial artery are even more unusual.2 They may cause arterial embolism and threaten the extremities. The risk of limb loss can be avoided by prompt diagnosis and early surgery.3 The best therapeutic option is operative repair, and it should be performed without delay, in order to prevent upper-extremity ischemic sequelae.
Address for reprints: Omer Tetik, MD, Department of Cardiovascular Surgery, Ataturk Training & Research Hospital, 35360, Yesilyurt, Izmir, Turkey