Abstract
The authors present an unusual case of a 3-year-old girl who was diagnosed with a fast-growing brachial aneurysm due to tuberous sclerosis. The patient was submitted to aneurysm resection and microsurgical reconstruction with reversed greater saphenous vein graft at the same time. She had a favorable follow-up, without neuromuscular deficits. Doppler ultrasonography has been performed for diagnosis, vein graft choosing, and postoperative follow-up. It is the opinion of the authors that such combined approach may be the routine for pediatric vascular reconstructions. Finally, this reconstruction has been rarely reported in tuberous sclerosis patients.
Highlights
CASE REPORTA 3-year-old girl presented to the vascular surgery team with a pulsatile mass in the left upper limb, in the transition between axilla and arm (figure 1)
The reconstruction of major arteries in small children is unusual and may be challenging[1,2]. This is because the caliber of these arteries may not allow for conventional vascular interventions, which may lead to the need for microvascular anastomoses requiring a combined team approach
The patient had a previous diagnosis of tuberous sclerosis, with a history of seizures totally controlled with anticonvulsant therapy, and hypochromic spots through the trunk skin
Summary
A 3-year-old girl presented to the vascular surgery team with a pulsatile mass in the left upper limb, in the transition between axilla and arm (figure 1). Doppler ultrasonography was performed right at that first consultation (figure 2) and diagnosed an arterial aneurysm in the transition between left axillary and brachial arteries (predominantly affecting the latter), sizing 3.6 cm in diameter. Upper limb revascularization after aneurysm resection plexus in the cubital region should be preserved, especially the basilic vein, which may be used as a graft. On the fourth postoperative day, immobilization was removed and shoulder was adducted Another Doppler ultrasonography was performed before allowing the patient to move her operated limb, and no flow decrease was found in any position. On the sixth postoperative day, the patient left the intensive care unit, and on the seventh day, she was discharged from hospital She returned to the doctor’s office weekly, and neither vascular nor healing problems were detected.
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