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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
 
Tex Heart Inst J. 2010; 37(5): 618–619.
PMCID: PMC2953228

True Brachial Artery Aneurysm

Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, 6624 Fannin St., Suite 2480, Houston, TX 77030

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.

figure 29FF1
Fig. 1 Angiographic view of the right brachial artery aneurysm.

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).

figure 29FF2
Fig. 2 Operative view of the right brachial artery aneurysm.
figure 29FF3
Fig. 3 Resected aneurysm.
figure 29FF4
Fig. 4 After aneurysmectomy, a saphenous vein graft was interposed to bypass the right brachial artery lesion.
figure 29FF5
Fig. 5 A) This high-magnification photomicrograph shows medial degeneration characterized by deposition of ground substance proteoglycans (H & E, orig. ×200). B) Note disruption (arrow) of the elastic laminae (van Gieson stain, orig. ×100). ...

Comment

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.

Footnotes

Address for reprints: Omer Tetik, MD, Department of Cardiovascular Surgery, Ataturk Training & Research Hospital, 35360, Yesilyurt, Izmir, Turkey

E-mail: moc.liamtoh@kitet;f5000x#&remo

References

1. Bahcivan M, Yuksel A. Idiopathic true brachial artery aneurysm in a nine-month infant. Interact Cardiovasc Thorac Surg 2009;8(1):162–3. [PubMed]
2. Schunn CD, Sullivan TM. Brachial arteriomegaly and true aneurysmal degeneration: case report and literature review. Vasc Med 2002;7(1):25–7. [PubMed]
3. Fann JI, Wyatt J, Frazier RL, Cahill JL. Symptomatic brachial artery aneurysm in a child. J Pediatr Surg 1994;29(12):1521–3. [PubMed]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute