Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 23-24

True Idiopathic Brachial Artery Aneurysm: A Rare Case of Surgical Emergency


1 Department of Cardiothoracic and Vascular Surgery, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
2 Department of Pathology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India

Date of Web Publication10-Jan-2017

Correspondence Address:
Nayem Raja
Department of Cardiothoracic and Vascular Surgery, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.198072

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  Abstract 

We report a case of true brachial artery aneurysm of idiopathic origin in a 53-year-old man complicated by distal thromboembolism resulting in acute critical upper limb ischemia. True aneurysm of the brachial artery is a very rare condition which may be asymptomatic or rarely present with acute thromboembolic episode. Surgical repair is the mainstay of treatment in these cases.

Keywords: Acute upper limb ischemia, brachial artery aneurysm, interposition venous graft


How to cite this article:
Raja N, Kisku N, Gupta L, Geelani MA. True Idiopathic Brachial Artery Aneurysm: A Rare Case of Surgical Emergency. Indian J Vasc Endovasc Surg 2017;4:23-4

How to cite this URL:
Raja N, Kisku N, Gupta L, Geelani MA. True Idiopathic Brachial Artery Aneurysm: A Rare Case of Surgical Emergency. Indian J Vasc Endovasc Surg [serial online] 2017 [cited 2019 Dec 10];4:23-4. Available from: http://www.indjvascsurg.org/text.asp?2017/4/1/23/198072


  Introduction Top


Brachial artery aneurysm is a rare entity of which most of them are pseudoaneurysms.[1],[2],[3] True aneurysm of brachial artery is very rare and may be due to atherosclerosis, congenital connective tissue disorders, repetitive trauma, Kawasaki syndrome, Buerger's disease, or idiopathic.[4] Mostly it is asymptomatic, however, may present with features of distal embolism along with a pulsatile mass over the arm.[1] We report a rare case of idiopathic true brachial artery aneurysm of the right brachial artery complicated by acute right upper limb ischemia.


  Case Report Top


A 53-year-old nonsmoker, nonhypertensive male with no history of trauma, infection, and no family history suggestive of connective tissue disorder, presented with acute right upper limb ischemia along with a pulsatile mass of 4 cm diameter over right mid-arm. Doppler study revealed an aneurysmal sac arising from the right brachial artery in its mid-portion with echogenic debris inside the sac and the distal brachial artery with no flow in distal brachial, radial, and ulnar arteries. Urgent intervention under right brachial plexus block in the form of excision of the saccular aneurysm arising from the right brachial artery was done. Morphologic features of aneurysm were suggestive of true aneurysm [Figure 1]. Distal thromboembolectomy was done using a Fogarty catheter and an interposition reversed saphenous venous graft was used for brachial artery reconstruction [Figure 2]. Both the proximal and distal anastomoses of the reversed saphenous venous graft was done in the end to side fashion. Postoperatively, both radial and ulnar pulses were palpable, and graft patency was confirmed by a Doppler study at 2 months follow-up.
Figure 1: (a) shows the aneurysm in the submuscular plane; (b) shows the morphologic features of a true aneurysm

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Figure 2: Intraoperative images of surgical repair of Right Brachial artery after aneurysm excision. (a) shows the proximal anastomosis of the interposition venous graft. (b) shows the completed repair with the interposition venous graft

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Histopathological examination of the excised specimen of the aneurysm showed disorganization and disruption of the internal elastic lamina with the presence of all the layers of vessel wall, confirmed by hematoxylin and eosin and Verhoeff-Van Gieson stain, suggestive of true aneurysm of the brachial artery [Figure 3].
Figure 3: Histopathological images. (a) H and E image showing the vessel wall with attached organized thrombus (×20). (b) Verhoeff-Van Gieson image showing degraded and degenerated elastin fibers of the vessel wall (×40). (c) H and E image of the vessel wall showing flattened endothelium with medial sclerosis and hypertrophy (×40)

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  Discussion Top


Peripheral artery aneurysms of the upper extremity are rare of which brachial artery aneurysm is rarer with an incidence of about 0.5% of all peripheral artery aneurysms.[5],[6] Brachial artery aneurysms are mostly pseudoaneurysms resulting from trauma, drug abuse or iatrogenic procedures.[7],[8] A very few cases of true aneurysm of the brachial artery have been reported in literature. Clinical presentations are varied ranging from asymptomatic mass over arm to features of distal thromboembolism rarely.[1] Prompt surgical repair is the recommended modality of treatment in all these cases to prevent catastrophic complications.[1],[2],[6],[8] Our case of Idiopathic true aneurysm of the right brachial artery presented with acute critical right upper limb ischemia with a mass over mid arm and an urgent surgical repair with an autologous interposition reversed saphenous venous graft and thromboembolectomy was done.


  Conclusion Top


True aneurysmal degeneration of the brachial artery is a very rare occurrence which may rarely present with an acute thromboembolic phenomenon distally. Surgical repair without delay is warranted and is the recognized modality of treatment for it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Gray RJ, Stone WM, Fowl RJ, Cherry KJ, Bower TC. Management of true aneurysms distal to the axillary artery. J Vasc Surg 1998;28:606-10.  Back to cited text no. 1
    
2.
Tetik O, Ozcem B, Calli AO, Gurbuz A. True brachial artery aneurysm. Tex Heart Inst J 2010;37:618-9.  Back to cited text no. 2
    
3.
Schunn CD, Sullivan TM. Brachial arteriomegaly and true aneurysmal degeneration: Case report and literature review. Vasc Med 2002;7:25-7.  Back to cited text no. 3
    
4.
Fakhree MB, Azhough R, Hafez Quran F. A case of true brachial artery aneurysm in an elderly male. J Cardiovasc Thorac Res 2012;4:25-7.  Back to cited text no. 4
    
5.
Bahcivan M, Yuksel A. Idiopathic true brachial artery aneurysm in a nine-month infant. Interact Cardiovasc Thorac Surg 2009;8:162-3.  Back to cited text no. 5
    
6.
Clarke MT, Waterland PW, Bahia SS, Asquith JR, Pherwani AD, Wong JC. True brachial artery aneurysm: A rarity. EJVES Extra 2012;23:e27-8.  Back to cited text no. 6
    
7.
Timaran CH. Upper extremity aneurysms. In: Cronenwett JL, Johnston KW, editors. Rutherford's Vascular Surgery. 7th ed. Philadelphia: Saunders Elsevier; 2010. p. 2138-9.  Back to cited text no. 7
    
8.
Hudorovic N, Lovricevic I, Franjic DB, Brkic P, Tomas D. True aneurysm of brachial artery. Wien Klin Wochenschr 2010;122:588-91.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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