Upper Extremity Aneurysms

Abstract

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