Brachial Artery Aneurysms: A 22-year Experience
Anita Nguyen1, Tiziano Tallarita2, Indrani Sen2, Jason Beckermann2, Young Erben3, Victor Davila4, Thomas Carmody2, Randall DeMartino1.
1Mayo Clinic, Rochester, MN, USA, 2Mayo Clinic, Eau Claire, WI, USA, 3Mayo Clinic, Jacksonville, FL, USA, 4Mayo Clinic, Scottsdale, AZ, USA.
OBJECTIVES: True brachial artery aneurysms (TBAAs) are rare. A prior upper extremity dialysis access procedure, immunosuppression or connective tissue disorders seem to link more strongly to causation than atherosclerosis alone. There are no standardized guidelines on optimal management of TBAAs. We describe the clinical presentation and treatment outcomes of TBAAs at our institution.
METHODS: All patients evaluated for TBAA were reviewed from August 2000 to July 2022. Demographics, imaging, operative details, and outcomes were analyzed retrospectively.
RESULTS: Twenty-four patients (18 male, 6 female, median age 51 [range 1-75] years) with TBAA were identified. Atherosclerotic risk factors included hypertension in 19 (79%), a smoking history in 13 (54%), hyperlipidemia in 9 (38%), and coronary artery disease in 5 (21%). Seventeen (71%) had a history of end stage renal failure (94% had a prior fistula in the affected arm, 76% history of kidney transplant, and 59% were taking immunosuppressants), 4 (17%) had a history of aneurysm at other locations, and 3 (13%) had been diagnosed with a connective tissue disorder. Fourteen (58%) were symptomatic at the time of presentation, with 11 (46%) complaining of local pain. Median aneurysm size was 25 mm (range 5-88 mm). Nineteen (79%) patients underwent surgical repair for either symptoms (11/19 [58%]) or potential risk of distal embolization from thrombus (8/19 [42%]). Median aneurysm size in asymptomatic patients surgically treated was 25 mm (range 11-65 mm). Surgical reconstruction included interposition graft in 10 (53% [8 saphenous veins, 1 ringed PTFE graft and 1 cryopreserved graft]), bypass with nonreversed saphenous vein in 3 (16%), primary end-to-end brachio-brachial anastomosis in 3 (16%), simple ligation of the brachial artery in 2 (11%), and was unknown in 1 (5%). Two (11%) patients experienced postoperative complications (1 wound infection managed conservatively and 1 hematoma requiring evacuation). At mean follow-up of 4.2 years (± 5.2 years), 10/13 (77%) grafts remained patent. Three patients developed graft thrombosis but did not require restoration of in-line flow.
CONCLUSIONS: TBAA were most frequently identified in male patients with a history of arterio-venous fistula or connective tissue disorder. Surgical repair of true brachial artery aneurysms was performed for symptoms or presence of thrombus. Saphenous vein interposition graft was the most common reconstruction with good long-term outcomes.
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