True brachial artery aneurysm.

Abstract

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. 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). Fig. 2 Operative view of the right brachial artery aneurysm. Fig. 3 Resected aneurysm. Fig. 4 After aneurysmectomy, a saphenous vein graft was interposed to bypass the right brachial artery lesion. 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). ...