A Rare Axillary Artery Aneurysm with Limb-Threatening Ischemia

2009 ◽  
Vol 33 (1) ◽  
pp. 26-30
Author(s):  
Jodi J. Grimm ◽  
Nam Tran
Keyword(s):  
Atrial Fibrillation ◽  
Operating Room ◽  
Upper Extremity ◽  
Axillary Artery ◽  
Secondary Infection ◽  
Bypass Graft ◽  
Outlet Obstruction ◽  
Artery Aneurysm ◽  
Pulsatile Mass ◽  
Embolism And Thrombosis

Introduction Isolated subclavian or axillary artery aneurysms are extremely rare, accounting for less than 3% of peripheral aneurysms. These aneurysms can be caused by a secondary infection such as syphilis, trauma, Ehler – Danlos syndrome, poststenotic dilation from thoracic outlet obstruction, arthrosclerosis, or congenital reasons. They are at risk for rupture, distal embolism, and thrombosis. These complications can cause limb loss and or death. Case Report An 80-year-old woman presented to the emergency room with a cold left upper extremity. The patient had a history of atrial fibrillation, congestive heart failure, and hypertension. A presumptive diagnosis of peripheral emboli was made because of the patient's atrial fibrillation and recent myocardial infarction. She was taken to the operating room for a thrombectomy of the left brachial, radial, and ulnar arteries. At that time, a pulsatile mass was noted on the patient's shoulder, and an ultrasound was ordered. The ultrasound revealed a left axillary artery aneurysm measuring 3.62 cm anteroposteriorly x 3.72 cm transverse. There was nonocclusive thrombus within the lumen of the aneurysm. There was diminished, monophasic flow in the axillary and brachial arteries. Postoperatively the patient was placed on intravenous heparin. She was taken back to the operating room where a 7-mm Dacron graft was placed between the left axillary and brachial artery with exclusion of the axillary artery aneurysm. On postoperative duplex the bypass graft was patent. The patient did not suffer any long-term complications as the result of ischemia. Conclusion Although upper-extremity aneurysms are rare, and little is known about the natural history, there are multiple documented limb-threatening and or life-threatening complications. It is essential that they be treated in a timely manner as to avoid limb-threatening complications. An ultrasound can provide a noninvasive method of detecting a subclavian-axillary aneurysm. It can be used to screen patients when there is a suspicion of an aneurysm and determine the presence of concomitant thoracic or abdominal aneurysm.

Upper Extremity Aneurysms

2016 ◽  
Author(s):  
Scott M. Damrauer ◽  
Ron M. Fairman
Keyword(s):  
Upper Extremity ◽  
Subclavian Artery ◽  
Axillary Artery ◽  
Outlet Obstruction ◽  
Artery Aneurysm ◽  
Covered Stent ◽  
Aberrant Right Subclavian Artery ◽  
Great Vessel ◽  
Computed Tomographic ◽  
Great Vessels

Aneurysms of the upper extremity arteries can be divided into those that occur in the central great vessels and those that occur in the arteries of the upper extremity. Aneurysms of the great vessels tend to be atherosclerotic in nature and are frequently the extension of an arterial field defect in patients with other aneurysmal disease. In contrast, aneurysms of the upper extremity arteries are mostly pseudoaneurysms that result from either acute or recurrent trauma or iatrogenic injury. Although the underlying principles of management are similar, the magnitude of the operations vary significantly. This review covers aneurysms of the great vessels and aneurysms of the peripheral upper extremity arteries. Figures show a computed tomographic angiogram demonstrating bilateral subclavian artery aneurysms in an individual with Marfan disease; the aberrant right subclavian artery originating from the thoracic aorta distal to the left subclavian orifice and coursing behind the esophagus as it travels back to the right hemithorax and arm; arterial thoracic outlet syndrome associated with compression of the subclavian artery as it travels through the scalene triangle and between the first rib and clavicle; the extent of arterial replacement necessary to treat great vessel aneurysms; isolated great vessel aneurysms with adequate proximal and distal landing zones treated with endovascular placement of a covered stent; hybrid operations combining endovascular exclusion of the great vessel aneurysm and transcervical extra-anatomic revascularization as an alternative to open surgery when placement of a traditional stent graft is not anatomically feasible; and an angiogram demonstrating a traumatic axillary artery. Tables list symptoms associated with great vessel aneurysms, distribution of aneurysm locations in the major series of great vessel aneurysms, and  outcomes of major series of great vessel aneurysms.  This review contains 7 highly rendered figures, 3 tables, and 68 references. Key words: axillary artery aneurysm; great vessel aneurysm; peripheral upper extremity aneurysm; subclavian artery aneurysm; thoracic outlet obstruction; upper extremity aneurysm

Axillo-Axillary Artery Bypass With Coil Embolization of the Innominate Artery for a Traumatic Innominate Artery Aneurysm: A Case Report

2018 ◽  
Vol 52 (7) ◽  
pp. 573-578 ◽  
Author(s):  
Ryota Sugisawa ◽  
Masaki Sano ◽  
Naoto Yamamoto ◽  
Kazunori Inuzuka ◽  
Hiroki Tanaka ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Coil Embolization ◽  
Axillary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Infection ◽  
Artery Aneurysm ◽  
Innominate Artery ◽  
Neurological Deficits ◽  
Cervical Region

Background: Innominate artery aneurysm (IAA) is a rare cervical artery aneurysm. Although atherosclerosis is its most common cause, IAAs due to cervical injury are often reported. Operative indications for IAAs include rupture or symptomatic aneurysm, saccular aneurysm, aneurysm with a diameter of 3 cm or greater, and aneurysmal change of the origin of the innominate artery. Although the ligature of the innominate artery or open surgical repair is well described, the usefulness of endovascular repair has also recently been reported. Herein, we report a case of traumatic IAA with infection in the cervical region after tracheostomy. Case Presentation: A 40-year-old man with cholecystolithiasis planned to undergo laparoscopic cholecystectomy at another hospital. Urgent tracheostomy was performed because of laryngeal edema at the induction of general anesthesia. Enhanced computed tomography angiography 1 week after the tracheostomy revealed a saccular IAA. The patient was deemed to be at high risk for aneurysm rupture and was referred to our hospital. Preoperative Matas test, Allcock test, and innominate arterial stump pressure measurement were performed to assess the cerebral blood flow and ischemic tolerance of the brain. These examinations showed the patency of the circle of Willis. An axillo-axillary artery bypass with coil embolization of the innominate artery was performed to avoid postoperative vascular graft infection. No postoperative complications such as infection or cerebral infarction occurred. Magnetic resonance imaging angiography performed 6 months after surgical treatment showed that the aneurysm had disappeared, and patency of the bypass graft was present. There were no postoperative complications, such as neurological deficits or graft infection, at more than 5 years after surgery. Conclusions: We report a successfully treated case of IAA after tracheostomy. Axillo-axillary artery bypass with coil embolization of the innominate artery is an effective treatment of IAA with cervical infection.

scholarly journals Long-term intra-arterial shunt

2020 ◽  
Vol 5 (1) ◽  
pp. e000486 ◽  
Author(s):  
David V Feliciano
Keyword(s):  
Operating Room ◽  
Upper Extremity ◽  
Thoracic Aorta ◽  
Axillary Artery ◽  
Damage Control ◽  
Uneventful Recovery ◽  
Axillary Vein ◽  
Descending Thoracic Aorta ◽  
Resuscitative Thoracotomy ◽  
The Right

This is a case report of a patient who sustained a stab wound to the right axilla with injuries to the right axillary artery and vein. The patient had near-exsanguination in the field and no recordable blood pressure upon admission to the trauma center. Resuscitation was performed with endotracheal intubation, a left anterolateral resuscitative thoracotomy with cross-clamping of the descending thoracic aorta, and the rapid infusion of crystalloid solutions and packed red cells. In the operating room, the third portion of the right axillary artery and the adjacent right axillary vein were found to be transected. As part of a ‘damage control’ procedure, the ends of the right axillary vein were ligated. A 14 French intra-arterial shunt was inserted into the transected ends of the right axillary artery to restore the flow to the right upper extremity. The patient’s postoperative course was complicated by a coagulopathy, adult respiratory distress syndrome (ARDS), and anuria. The coagulopathy and anuria resolved within the first 48 hours, but the patient’s ARDS was slow to resolve. On the 10th postinjury day, the patient was returned to the operating room for a definitive repair of the right axillary artery. After the intra-arterial shunt was removed, a reversed greater saphenous vein graft was inserted between the ends of the right axillary artery in a medial intermuscular (extra-anatomic) tunnel. The patient made an uneventful recovery and was discharged home on the 16th postinjury day.The following principles of advanced trauma care were part of the management of this patient: (1) occasional need for resuscitative thoracotomy with cross-clamping of the descending thoracic aorta in a patient without a thoracic injury; (2) ‘damage control’ operation with ligation of the right axillary vein and placement of a temporary intra-arterial shunt to restore the flow to the right upper extremity; and (3) vascular reconstruction with an extra-anatomic bypass in a previously contaminated field.

Plasma n-3 and n-6 fatty acids and the incidence of atrial fibrillation following coronary artery bypass graft surgery

2011 ◽  
Vol 41 (9) ◽  
pp. 995-1003 ◽  
Author(s):  
Gudrun V. Skuladottir ◽  
Ragnhildur Heidarsdottir ◽  
David O. Arnar ◽  
Bjarni Torfason ◽  
Vidar Edvardsson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Fatty Acids ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft

scholarly journals Iliac Artery Aneurysm Repair with Preservation of a Single Ectopic Pelvic Kidney

2015 ◽  
Vol 42 (1) ◽  
pp. 61-62
Author(s):  
Aurelio Sarralde ◽  
Carolina Perez-Negueruela ◽  
José M. Bernal
Keyword(s):  
Renal Artery ◽  
Iliac Artery ◽  
Saline Solution ◽  
Bypass Graft ◽  
Artery Aneurysm ◽  
Systemic Circulation ◽  
Pelvic Kidney ◽  
Iliac Artery Aneurysm ◽  
Cold Saline ◽  
One Year

An ultrasonographic study in a 60-year-old man incidentally detected an iliac artery aneurysm that gave rise to the renal artery of a single ectopic pelvic kidney. Renal-preservation solution could not be used during surgery, because the unclamped renal vein would have enabled the solution to enter the systemic circulation. Therefore, cold saline solution was infused through the renal ostium, and the kidney was maintained under cold saline immersion. We performed aortoiliac bypass and then implanted the renal artery into the bypass graft. Postoperatively, the patient's serum creatinine level increased; after one year, his renal function was normal. We discuss our use of cold saline solution for renal preservation.

Perioperative cardiac troponin T and risk of postoperative atrial fibrillation in coronary artery bypass graft surgery

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ali Vasheghani Farahani ◽  
Abbas Salehi Omran ◽  
Kyomars Abbasi ◽  
Ali Gholamrezaei ◽  
Pejman Mansouri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cardiac Troponin T ◽  
Artery Bypass Graft
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