Cephalic venous aneurysm in the wrist

Giant cephalic venous aneurysm

The occurrence of venous aneurysms (VAs) is very rare, and VAs have been seldom reported in the existing literature. The etiology leading to the formation of VAs has not yet been determined. The presentation can range from asymptomatic to painful thrombosis of the sac, with rare events of pulmonary embolism. We have reported the case of a patient who had had a large cephalic vein aneurysm that was treated successfully. A 39-year-old man had presented with swelling in the left forearm that had progressively increased in size for 2 years and was associated with discomfort. On examination, a 5 × 5-cm soft compressible lesion was present over the mid-forearm that disappeared with raising of the arm. Contrast-enhanced magnetic resonance imaging showed a well-defined lesion arising from the cephalic vein. Under local anesthesia, after proximal and distal ligation, the aneurysm was excised. The histopathologic examination showed a thinned out smooth muscle wall and multifocal absence of the smooth muscle layer. The patient was doing well at 1 year of follow-up with no further degeneration in the vein wall. The formation of VAs might result from endophlebohypertrophy and endophlebosclerosis of the veins at the site of recurrent stress. Surgical excision should be considered when the patient is symptomatic, cosmetic disfigurement is present, and/or complications such as venous thrombosis, pulmonary embolism, and/or nerve compression have developed.

Cephalic Vein Aneurysm in the Distal Forearm Managed with Sclerotherapy-A Rare Case Report and Literature Review

Venous aneurysm of upper extremities is rare entity. We report a rare case of large cephalic vein (CV) aneurysm in a 41-year-old man who presented as slowly growing painless swelling at distal forearm along the lateral aspect. Duplex ultrasound showed aneurysm originating from the anterior wall of the CV with venous waveform pattern on Doppler. It was managed successfully with percutaneous sclerotherapy.

Management of upper extremity aneurysms: a systematic review

INTRODUCTION

The aim of this paper is to provide recommendations for diagnosis and management of arterial or venous aneurysms of the upper extremity.

EVIDENCE ACQUISITION

A systematic review of the Medline and Cockrane databases was performed from 1988 to 2019 by a combined strategy of MeSh terms.

EVIDENCE SYNTHESIS

One-hundred-forty-four publications were identified: 111 addressing arterial aneurysms and 33 addressing venous aneurysms. A total of 162 cases of arterial aneurysms, mostly brachial aneurysms (34.0% of cases) and 40 cases of venous aneurysms, mostly located in the forearm (60.0% of cases) were reported. For both types of aneurysms, most common presentation was the perception of a mass (56.3% for arterial one and 87.5% for venous one), but thromboembolic complication (46.7%), paresthesia (16.5%) or rupture (6.4%) could be observed in the setting of arterial aneurysms, while arm swelling (27.5%), neurological symptoms (12.5%), pulmonary embolism (10.0%) or rupture (2.5%) could occur in the setting of venous aneurysms. DUS was performed as first imaging modality for both settings, followed but CTA and MRA, especially in arterial aneurysms, to evaluate distal emboli and surrounding vasculature. Surgical treatment was mostly based on excision of the aneurysms with revascularization for arterial aneurysms (77.2%) and resection without reconstruction for the venous one (85.0%). Complications occurred in 10.5% of the cases of arterial aneurysms, none occurred after venous aneurysm resection.

CONCLUSIONS

Prompt diagnosis and appropriate preoperative imaging are mandatory in order to offer the best treatment modality. Open resection with revascularization seems to be the treatment of choice for arterial aneurysms, although endovascular procedures became more popular. Venous aneurysms require excision without revascularization.