MANAGEMENT OF TRUE ANEURYSMS DISTAL TO THE AXILLARY ARTERY

Objective: To delineate management strategies and outcomes for true an eurysms involving arteries of the upper extremity distal to the axilla ry artery. The management of these rare lesions has not been well esta blished in the literature. Methods: Retrospective chart review was per formed at tertiary referral centers. All patients who received the dia gnosis of true upper extremity aneurysms, distal to the axillary arter y between 1975 and 1995 were included in the review. Nineteen patients were found; seven were excluded because no confirmatory diagnostic im aging study or operative exploration was performed. This represents th e largest reported series of true upper extremity arterial aneurysms. Results: Twelve patients (9 men or boys) had 12 confirmed true aneurys ms of the brachial or more distal arteries. The average diameters a er e as follows: brachial artery 4.6 cm, radial artery 2.0 cm, ulnar arte ry 1.4 cm, and digital artery 0.8 cm. The mean age was 51 pears (range , 10 to 86 years). The most common presentation was the presence of a mass. This occurred among eight patients (67%). Four patients (33%) re ported pain or paresthesia. One patient (8%) had cold intolerance only . Three patients (25%) had thromboembolic complications. Complications did not consistently correlate with size or presence of intramural th rombus. Three aneurysms (25%) were initially managed nonoperatively an d followed for a mean period of 71 months. One of these required opera tive repair after 5 months because of progressive pain. Ten patients ( 83%) were treated surgically as follows: five underwent ligation and e xcision only, and five underwent excision and revascularization. Morbi dity was minimal, and there were no perioperative deaths. Conclusion: True arterial aneurysms of the upper extremity distal to the axillary artery are rare and most commonly caused by blunt trauma. Fifty-eight percent of these lesions present with symptoms or complications. Thirt y-three percent of asymptomatic lesions later become symptomatic. Thes e factors combined with the minimal morbidity associated with repair s uggest that operative repair should be routinely performed for these a neurysms. Revascularization can be performed selectively.