Surgical treatment of aneurysms in the upper limbs

Abstract

Objective: The purpose of this study was to review the experience of aneurysms in the upper limbs treated with surgery and assess the outcomes.

Materials and methods: This study retrospectively reviewed the medical records of five patients with upper extremity aneurysms treated with surgical resection at Tokyo Medical and Dental University Hospital between March 2000 and February 2012. These patients were treated with excision surgery either with or without reconstructive surgery.

Results: Two of the five patients were males and three were females with a mean age of 52 years (age range: 25-72 years). We treated 2 brachial, 2 ulnar, and 1 radial aneurysms. All aneurysms were excised, and two patients had reconstructive surgery. Three patients had false aneurysms, which included an ulnar artery aneurysm diagnosed as angiolymphoid hyperplasia with eosinophilia. During follow-up period, all grafts were clinically patent, and no cases had recurrent lesions. No patients had ischemic symptoms or any other postoperative complications.

Conclusion: Arterial aneurysms of the upper extremities are uncommon, and were most commonly caused by non-traumatic etiology in this series. These aneurysms were excised with or without reconstructive surgery, because of the fear of rupture and embolization. Revascularization can be performed selectively.

Keywords: aneurysm; reconstruction; trauma; upper extremity.

Fig. 1

Patient No. 2 (a) Photograph shows exploration of the aneurysm during surgery. (b) Postoperative photograph showed the interposed vein graft (white arrow).

Fig. 2

Patient No. 3 (a) Computed tomography (CT) showed an aneurysm of the left ulnar artery (white arrow). (b) Microscopic images showed multiple proliferating small vessels in the aneurysmal wall that were infiltrated with numerous eosinophils (hematoxylin - eosin stain × 100).