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Management of positional axillary artery compression in a baseball pitcher with embolic ischemia of the upper extremity. J Shoulder Elbow Surg 2022; 31:e451-e458. [PMID: 35738545 DOI: 10.1016/j.jse.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023]
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Mendes D, Vaz C, Machado R, Almeida R. Hybrid Approach of a Complex Aneurysm of the Subclavian-Axillary-Brachial Axis: A Case Report. Vasc Endovascular Surg 2022; 56:784-789. [PMID: 35759363 DOI: 10.1177/15385744221110404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Upper extremity arterial aneurysms are a rare, potentially limb-threatening disorder. Due to its rarity, the best treatment modality and outcomes are not entirely established; however, there is a consensus that open surgery is the first-line treatment. We present a complex case of an arterial aneurysm of the subclavian-axillary-brachial axis adequately treated using a hybrid surgical and endovascular treatment. CASE PRESENTATION A 59-year-old man presented to the emergency department with acute ischemia of the right upper limb. An extensive thrombosed aneurysm of the subclavian-axillary-brachial axis was identified. The treatment was carried out in two stages. In the first phase, urgent limb revascularization was performed using the great saphenous vein to perform a subclavian-brachial artery bypass. Later, the aneurysm was excluded using a vascular plug and multiple coils. Successful treatment was achieved with no morbidity for the patient. CONCLUSIONS Although the gold standard for treating upper limb aneurysms is open surgery, endovascular techniques can be a significant adjunct, reducing treatment morbidity and even mortality.
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Affiliation(s)
- Daniel Mendes
- Department of Angiology and Vascular Surgery, 112085Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carolina Vaz
- Department of Angiology and Vascular Surgery, 112085Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rui Machado
- Department of Angiology and Vascular Surgery, 112085Centro Hospitalar Universitário do Porto, Porto, Portugal.,Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto (UP), Porto, Portugal
| | - Rui Almeida
- Department of Angiology and Vascular Surgery, 112085Centro Hospitalar Universitário do Porto, Porto, Portugal.,Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto (UP), Porto, Portugal
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Montanari F, Codispoti FA, Tinelli G, Minelli F, Tshomba Y. A Rare Case of Dysplastic Axillary Artery Aneurysm Associated with Arteriovenous Malformation. Ann Vasc Surg 2020; 71:536.e9-536.e14. [PMID: 33157250 DOI: 10.1016/j.avsg.2020.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 08/25/2020] [Accepted: 09/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Axillary artery aneurysms are rare conditions, and their causes are various. They can determine severe complications, so the treatment is extremely important. METHODS We report the case of a young man affected by a saccular axillary artery aneurysm associated with intramuscular arteriovenous malformation, without symptoms except for the presence of a pulsatile mass. Duplex scan and computed tomography scan have been essential for a correct diagnosis and planning of the treatment. At first, the patient was submitted to coil embolization of an efferent vessel, and then he was treated surgically through ligation and detachment of the aneurysm and replacement of part of the axillary artery with a Dacron graft (Vascutek, Inchinnan, Renfrewshire, Scotland, UK). RESULTS Follow-up at 1 and 6 months revealed normal patency of the axillary arterty and the prosthetic graft with complete exclusion and thrombosis of the aneurysm sac.No sensitive nor motor deficit were observed. CONCLUSIONS Aneurysms of the axillary artery associated with intramuscular arteriovenous malformations are very rare, but have to be suspected. The treatment is challenging and can be surgical, endovascular, or hybrid, based on the patient's conditions and aneurysm's anatomical features.
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Affiliation(s)
- Francesca Montanari
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | | | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabrizio Minelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Kuntz S, Lejay A, Georg Y, Thaveau F, Chakfé N. Management of upper extremity aneurysms: a systematic review. INT ANGIOL 2020; 39:161-170. [PMID: 32052949 DOI: 10.23736/s0392-9590.20.04307-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France - .,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France.,Department of Physiology, University Hospital of Strasbourg, Strasbourg, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
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Tham SL, Guo Y, Pang MCY, Chng JK. Surgical Management of Axillary Artery Aneurysms with Endovascular Stenting versus Open Repair: A Report of Two Cases and Literature Review. Ann Vasc Surg 2019; 58:385.e11-385.e16. [PMID: 30763704 DOI: 10.1016/j.avsg.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/20/2018] [Indexed: 01/10/2023]
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Epstein DA, Ibrahim MT, Franz RW. Endovascular Treatment of Massive Axillary Artery Aneurysm for Palliation. Vasc Endovascular Surg 2017; 51:188-190. [PMID: 28424041 DOI: 10.1177/1538574417691711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atherosclerotic axillary artery aneurysms are rare. We report a case of a ninety six year old female who presented with a pulsatile left breast mass causing her intractable pain. She was diagnosed with a massive axillary artery aneurysm which was treated with and endovascular aneurysm repair for palliation of her symptoms.
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Leake SS, Sandhu H, Charlton-Ouw KM, Azizzadeh A. Axillary artery thrombosis in a baseball pitcher. J Vasc Surg Cases 2015; 1:168-170. [PMID: 31724563 PMCID: PMC6849898 DOI: 10.1016/j.jvsc.2015.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/17/2015] [Indexed: 12/03/2022] Open
Abstract
Isolated nonatherosclerotic axillary artery disease is a rare condition. External axillary artery compression can result in occlusion or aneurysm formation and subsequent upper extremity ischemia or distal thromboembolism. Chronic compression from use of crutches and repetitive stretching/compression of the axillary artery secondary to overhead motion during high-performance athletic activities are often implicated as the cause. The uniqueness of these lesions and clinical setting requires a high index of suspicion for axillary artery pathology. Prompt diagnosis with arteriography and surgical treatment is necessary given the propensity for thromboembolism. We present a case highlighting this rare phenomenon in a collegiate baseball pitcher.
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Affiliation(s)
- Samuel S Leake
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Tex
| | - Harleen Sandhu
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Tex.,Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart &Vascular Institute, Texas Medical Center, Houston, Tex
| | - Kristofer M Charlton-Ouw
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Tex.,Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart &Vascular Institute, Texas Medical Center, Houston, Tex
| | - Ali Azizzadeh
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Tex.,Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart &Vascular Institute, Texas Medical Center, Houston, Tex
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He C, Wu X, Cao J, Fan X, Liu K, Liu B. Endovascular management of spontaneous axillary artery aneurysm: a case report and review of the literature. J Med Case Rep 2013; 7:140. [PMID: 23714201 PMCID: PMC3673813 DOI: 10.1186/1752-1947-7-140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 04/05/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Spontaneous atraumatic true axillary artery aneurysm is a relatively unusual disorder. Although most cases are asymptomatic, complications of axillary artery aneurysms may result in acute vascular insufficiency and neurological deficits. Prompt treatment, therefore, should be employed in the management of this condition. To date, the standard treatment for peripheral aneurysms is still surgical resection with end-to-end anastomosis. However, aneurysmectomy and interposition grafting with autologous or artificial vessels are more invasive and time-consuming. The ideal treatment for axillary artery aneurysm should be relatively noninvasive, safe and free of significant complications, cost-effective, cosmetically acceptable, and incur less absence from usual daily activities. Endovascular stent grafts have also been successfully used to treat these aneurysms. Management of select aneurysms using stent grafts has become more prevalent with the developing endoluminal technology. CASE PRESENTATION We report a case of a spontaneous atraumatic axillary artery aneurysm where the patient was a 48-year-old ethnic Han Chinese woman with a gradually enlarging left axillary pulsatile mass. She was treated with endovascular stent grafts. The postoperative course of the patient was uneventful during the six-month follow-up. CONCLUSIONS We show that there are significant early advantages with the endovascular management technique versus the conventional operation in the management of axillary artery aneurysm.
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Affiliation(s)
- Changsheng He
- Institute of General Surgery, Nanjing Jinling Hospital, 305 East Zhongshan Road, Nanjing 210002, China.
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Malik MK, Kraev AI, Hsu EK, Clement MHC, Landis GS. Spontaneous axillary artery aneurysm: a case report and review of the literature. Vascular 2012; 20:46-8. [DOI: 10.1258/vasc.2011.cr0293] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Degenerative arterial aneurysms can occur in any vascular territory. However, they are exceedingly rare in the axillary artery. Complications of axillary artery aneurysms may result in acute vascular insufficiency and neurological deficits. Prompt treatment should be employed in the management of this condition. We report a case of an atraumatic degenerative axillary artery aneurysm that was treated with transaxillary open surgical bypass.
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Affiliation(s)
- Manmeet K Malik
- Division of Vascular Surgery, New York Hospital Queens, 56–45 Main Street, Flushing, NY 11355, USA
| | - Alexander I Kraev
- Division of Vascular Surgery, New York Hospital Queens, 56–45 Main Street, Flushing, NY 11355, USA
| | - Ekai K Hsu
- Division of Vascular Surgery, New York Hospital Queens, 56–45 Main Street, Flushing, NY 11355, USA
| | - Michael-Hunter C Clement
- Division of Vascular Surgery, New York Hospital Queens, 56–45 Main Street, Flushing, NY 11355, USA
| | - Gregg S Landis
- Division of Vascular Surgery, New York Hospital Queens, 56–45 Main Street, Flushing, NY 11355, USA
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Mazzaccaro D, Malacrida G, Occhiuto MT, Stegher S, Tealdi DG, Nano G. Endovascular treatment of iatrogenic axillary artery pseudoaneurysm under echographic control: a case report. J Cardiothorac Surg 2011; 6:78. [PMID: 21619625 PMCID: PMC3123554 DOI: 10.1186/1749-8090-6-78] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 05/27/2011] [Indexed: 11/10/2022] Open
Abstract
Aim Brief case report of the treatment of a large axillary artery pseudoaneurysm after a pacemaker using a left brachial cutdown and a retrograde delivery of a covered stent using ultrasound and fluoroscopic guidance. The patient's renal function precluded the use of contrast materials. Case Report A 77 years old man presenting with acute renal failure and haemoglobin decrease arrived with an expanding pseudoaneurysm of the left axillary artery from a pacemaker placement. Considering the site of the lesion and patient's comorbidities, under echographic control, a Hemobahn® stent-graft was placed; fluoroscopy assisted manipulation of guidewires and sheaths into the aortic arch. The procedure was successfully ended without any complications. At 8 months the stent graft was still patent. Conclusion Ultrasound guidance may represent an alternative for pseudo-aneurysm exclusion without any use of contrast medium, especially in those patient where lesions are easily detectable using ultrasonography and when comorbidities contraindicate aggressive surgical or angiographic approach.
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Vasic D, Radmili O, Dragas M, Davidovic L, Vranes M. Bilateral isolated axillary aneurysms. Am Surg 2011; 77:E19-21. [PMID: 21396298 DOI: 10.1177/000313481107700113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dragan Vasic
- Vascular Surgery Clinic, Clinical Centre of Serbia, Belgrade, Serbia
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Endovascular treatment of ruptured axillary and large internal mammary artery aneurysms in a patient with Marfan syndrome. J Vasc Surg 2010; 53:478-82. [PMID: 21050698 DOI: 10.1016/j.jvs.2010.08.076] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/18/2010] [Accepted: 08/25/2010] [Indexed: 11/23/2022]
Abstract
Marfan syndrome is an autosomally inherited disorder affecting the synthesis of connective tissues. Vascular manifestations of Marfan syndrome include aneurysmal dilatation of the aortic root, aortic dissection, and rupture. Peripheral aneurysms are mostly reported in the iliac, femoral, and subclavian arteries. We report a Marfan patient with a ruptured axillary artery aneurysm and a large left internal mammary artery aneurysm. The axillary aneurysm was successfully excluded using covered stent grafts, and the left internal mammary artery aneurysm was effectively coiled. Duplex ultrasound imaging at 4 months and computed tomography at 9 months demonstrated complete thrombosis and exclusion of both aneurysms with patent subclavian-axillary stent grafts.
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Jun F, Shun ZY, Min LY, Xue QG, Yan TH, Hao Q, Li XX. Large-sized bilateral axillary artery aneurysms in a patient with marfan syndrome: a case report. Heart Surg Forum 2010; 13:E271-2. [PMID: 20719737 DOI: 10.1532/hsf98.20091199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 46-year-old man presented with large bilateral aneurysm of the axillary arteries combined with Marfan syndrome. Treatment consisted of axillary aneurysm resection and vessel replacement. Postoperative computed tomographic angiography confirmed good flow in the bilateral axillary artery, and the patient recovered without complication.
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Affiliation(s)
- Feng Jun
- First Affiliated Hospital, Xi'an Jiaotong University School of Medicine, China
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Michaluk BT, Deutsch E, Moufid R, Panetta TF. Endovascular Repair of an Axillary Artery Pseudoaneurysm Attributed to Hyperextension Injury. Ann Vasc Surg 2009; 23:412.e5-9. [DOI: 10.1016/j.avsg.2008.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 04/16/2008] [Accepted: 04/17/2008] [Indexed: 11/26/2022]
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