Corkscrew axillary artery with giant saccular aneurysm formation

Abstract

Axillary artery aneurysms are rare, with limited cases reported.1Rose J.F. Lucas L.C. Bui T.D. Mills Sr., J.L. Endovascular treatment of ruptured axillary and large internal mammary artery aneurysms in a patient with Marfan syndrome.J Vasc Surg. 2011; 53: 478-482Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar, 2Lind R.C. de Vries M. Rolink R. Oskam J. Pierie M.E. Surgical management of an isolated symptomatic true axillary artery aneurysm.Vasc Med. 2013; 18: 145-146Crossref PubMed Scopus (4) Google Scholar Coiling of the axillary arteries with formations of aneurysms are extremely uncommon.3Ortiz-Pomales Y. Smith J. Weiss J. Casey K. Tortuous axillary artery aneurysm causing median nerve compression.Ann Vasc Surg. 2014; 28: 122.e1-122.e3Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Symptoms can include acute vascular insufficiency and neurologic deficits. Treatment should address the coiling vessels and the aneurysms. An 86-year-old woman complaining of increasing right shoulder pain and swelling was transferred to our hospital’s Department of Vascular Surgery. She had been diagnosed with advanced liver cancer, with multiple systemic metastases, and had been hospitalized 7 days earlier in the oncology department for support therapy. The physical examination revealed a pulsatile mass on her right upper extremity. She had no history of trauma or connective tissue disorders and denied long-term use of crutches. A contrast-enhanced computed tomography angiogram showed a corkscrew axillary artery with giant saccular aneurysm formation, reaching 35 mm by 62 mm in size (A and B). Considering its corkscrew course, an endovascular intervention using stent grafts was not suitable. Resection of the coiled part of the axillary artery and an end-to-end anastomosis were planed. However, the patient’s general condition was not ideal either, with liver function grade classified as Child C, which placed her at extremely high-risk for an open operation. The patient died of hepatic failure 10 days later during the hospitalization.