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Pediatric nonaortic arterial aneurysms are uncommon diagnoses and can be affiliated with underlying conditions, which include neurofibromatosis I, Ehlers-Danlos type IV syndrome, Kawasaki disease, Marfan syndrome, and Loeys-Dietz, polyarteritis nodosa, as well as Klippel-Trenauny syndrome. The standard of care has been early surgical excision and arterial reconstruction when indicated. This report details a case of recurrent brachial artery aneurysm in a 2-year-old boy despite multiple attempts at excision and reconstruction. Such recurrences were seen as rapidly as 3 months postoperatively. Ultimately, a Gore-Tex conduit was used to reinforce a reversed saphenous vein graft repair. There has been no evidence of recurrent disease during the 18-month follow-up period.

Introduction This case describes a brachial artery mycotic aneurysm (BAMA) secondary to infective endocarditis caused by Enterococcus faecalis. BAMAs are rare and potentially limb or life threatening. A literature review revealed 61 cases since 1950, primarily caused by intravenous drug use, with Staphylococcus aureus being the most common causative bacteria. Report A 71 year old man with known infective endocarditis presented with pulsatile swelling in his right antecubital fossa. A BAMA was confirmed on duplex scan. The patient underwent prompt extra-anatomic bypass with an ipsilateral cephalic vein graft. Discussion Bacterial endocarditis should be acknowledged as a cause of BAMA. Prompt diagnosis and intervention are essential., Highlights • Brachial artery mycotic aneurysm (BAMA) secondary to infective endocarditis. • Only case reported to be caused by haematogenous spread of Enterococcus faecalis. • BAMAs are rare and can be potentially limb or life threatening. • One must acknowledge bacterial endocarditis as a cause of BAMA. • Prompt diagnosis and intervention are essential for good outcomes.

ResumoNos doentes com insuficiência renal crónica terminal o aneurisma da artéria umeral proximal a uma fístula arterio-venosa (FAV) é uma complicação rara e tardia. Os objectivos do estudo foram a caracterização clínica e demográfica destes doentes, a análise da terapêutica cirúrgica adoptada e seus resultados.A análise foi observacional e retrospectiva, durante um período de 10 anos (2002-12) relativa aos doentes insuficientes renais crónicos com transplante renal e aneurisma umeral em membros com FAV rádio-cefálica prévia. Foram excluídos doentes com pseudo-aneurismas relacionados com acessos vasculares.Seis doentes, 5 homens (83%) e 1 mulher (17%) com a idade média de 54 anos, transplante renal e FAV rádio-cefálica laqueada/ocluída foram avaliados. A apresentação clínica mais comum foi a de massa umeral pulsátil indolor. O diâmetro médio dos aneurismas foi de 32,5mm. Todos os doentes foram submetidos a ressecção do aneurisma e interposição umero-umeral de conduto venoso em 4 doentes, protésico em 1 doente e a anastomose topo-a-topo em 1 doente. No follow-up médio de 35 meses verificou-se num doente trombose de enxerto protésico aos 2 meses e em 2 doentes degenerescência aneurismática (33%) do enxerto venoso e/ou artéria umeral proximal à reconstrução vascular aos 53 e 60 meses, o que motivou nos três doentes segunda intervenção cirúrgica. Não se registaram casos de perda de membro ou de mortalidade. Remodeling expansivo provocado pelo alto débito e shear stress proximal à FAV no contexto de maior sobrevida dos doentes com transplante renal em relação aos doentes em hemodiálise e o eventual efeito da terapêutica imunossupressora, poderão explicar a ocorrência deste efeito degenerativo. O conduto de eleição deve ser o enxerto venoso pela sua maior permeabilidade, não obstante o seu potencial de dilatação subsequente, pelo que é indispensável um programa de vigilância rigoroso.AbstractIn patients with end-stage chronic kidney disease, brachial artery aneurysms proximal to an arteriovenous fistula are a rare and late complication. The aim of this study was clinical and demographic characterization of these patients and analysis of the outcomes of surgical treatment.An observational retrospective study was conducted comprising a period of 10 years (2002-2012) on receivers of kidney transplant with brachial artery aneurysms in limbs with a previously constructed radiocephalic fistula. Patients with access-related pseudo-aneurysms were excluded.Six patients – 5 male (83%) and 1 female (17%) – with an average age of 54 years, all of whom were kidney transplant recipients and had a ligated/occluded radio-cephalic fistula. The most common presentation was a painless pulsatile mass. Average aneurysm diameter was 32.5mm. All patients had their aneurysm resected. An interposition graft was placed in 5 patients - vein graft in 4 patients, prosthetic graft in 1 patient. End-to-end anastomosis was performed in 1 patient. The average follow-up was 35 months, with thrombosis of 1 prosthetic graft at 2 months, 2 patients suffered aneurysmal degeneration (33%) of the graft and/or brachial artery proximal to the reconstruction at 53 and 60 months, all requiring a second procedure. No fatalities or cases of limb loss were recorded.Expansive remodeling caused by high flow and shear stress proximal to an arteriovenous fistula associated with longer survival of kidney transplant recipients and the effect of immunosuppressive therapy may explain development of these aneurysms. Our results point out that venous conduit should be the preferred choice by its longer patency, although requiring a non-invasive surveillance program by the risk of late aneurysmal degeneration.

A patient with isolated right brachial artery aneurysms is presented. As a young woman these had been misdiagnosed, leading to inappropriate surgery and a subsequent brachial artery aneurysm produced median nerve neuropraxia. Resection of the aneurysm and bypass relieved these symptoms and the aetiology was fibromuscular dysplasia. The literature on fibromuscular dysplasia and aneurysms of the brachial artery are reviewed.

Aneurysmal dilatation can occur infrequently at the proximal site of an arteriovenous fistula probably because of abnormal wall stresses. However, there might be other intrinsic factors that contribute to aneurysmal formation besides the fistula, because only a very small number of patients with fistulae develop such an aneurysm. We describe herein the histopathological characteristics of a brachial artery aneurysm in a 57-year-old male patient on cholesterol apheresis through a radio-cephalic fistula, and the relationship of the aneurysm with the underlying disease is discussed.

Mycotic aneurysms are extremely rare. Osler introduced the term in 1885 to describe an aortic aneurysm that resulted from bacterial endocarditis [1]. Since then the term has been given a broad definition to describe aneurysms, true or false of any artery, induced by infection of existing atherosclerotic aneurysm, traumatic injury, drug abuse or due to sepsis, local or embolic. A case of brachial artery mycotic aneurysm is presented which developed following a neglected perianal abscess. No similar case has been reported in available literature.

The development of pan-arterial dilatation proximal to longstanding traumatic arteriovenous fistulae (AVF) was first described by John Hunter over two centuries ago. 1 This is thought to be due to abnormal and hyperdynamic arterial flow patterns proximal to the AVF, which renders the proximal arteries particularly susceptible to atherosclerotic change and aneurysmal dilatation. 2–4 Aneurysmal arterial dilatation has been described infrequently as a late complication of traumatic AVF formation, 5,6 however, we describe a case in which acute on chronic late brachial artery aneurysmal dilatation occurred following previous Brescia-Cimino AVF formation, which had been ligated several years earlier after renal transplantation.