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We report a case of 66-year-old woman with true aneurysm of the right brachial artery. She presented with acute upper extremity ischemia. The hand was cold and parenthesized and distal pulses were absent. CT angiography (CTA) revealed a 20*25 mm true brachial artery aneurysm. The aneurysm was thrombosed without distal run-off. We excised the aneurysm and reestablished the arterial flow by a reverse saphenous interposition graft. The postoperative course was uneventful.

The aim of this paper is to describe the case of a patient successfully treated for left brachial arterial aneurysm occurring 15 years after renal transplantation and consequent 8 years after arteriovenous fistula (AVF) ligation. We describe our experience and our surgical approach. A 45-year-old man presented to our attention for a large pulsatile formation on the volatile face of the left forearm, which he reported to have enlarged in the last year. He had a history of chronic renal impairment in 2000, then AVF for dialysis was realized, and he was finally addressed to kidney transplantation in 2004. In 2011 the AVF was ligated. We observed absence of radial pulse and direct flow on the ulnar artery; a large pulsatile formation was evident along the course of the left brachial artery, associated with forearm venous dilatation. Doppler ultrasound showed fusiform aneurysm of the brachial artery with 3.5 cm diameter and longitudinal extension of 5 cm up to the brachial bifurcation. We removed the brachial aneurysm, with a venous bypass on the ulnar artery. The patient was discharged in good general condition on the second postoperative day. At 1- and 6-month follow-up he had complete recovery with graft patency, without any neurological impairment and with a good esthetic result. An open surgical repair with great saphenous vein interposition seems to be the best choice in terms of patency and perioperative morbidity.

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: Brachial artery aneurysm (BAA) is a rare late complication of arteriovenous fistula (AVF). It brings the risk of peripheral embolism and hand ischemia and is defined by brachial artery diameter above 10 mm or by regional dilatation by >50%. BAA is described in the literature in closed radiocephalic arteriovenous fistulas after kidney transplantation. The aim of the study was to analyze the prevalence of BAA and of their more dangerous forms. Method: A observational one center study performed on patients after kidney transplantation with AVF or arteriovenous graft (AVG). We invited all patients followed up for kidney transplantation in our center. Arterial diameter greater than 10 mm was considered as a brachial artery aneurysm to simplify the detection and evaluation of aneurysms. Results: About 162 patients with AVF after kidney transplantation were examined between 4/2018 and 4/2020. Brachial artery aneurysm was detected in 34 patients (21%) with AVF or AVG, of them 7 had confirmed wall thrombi. AVF flow volume of more than 1500 ml/min increased the risk of BAA development by 4.54x. Eight aneurysms were treated surgically. After this surgery, the primary patency was 87.5% in 12 months. Conclusion: Brachial artery aneurysm was relatively frequent in our study compare to the literature. Aneurysm or dilatation of the brachial artery is more frequent in functional AVFs. Surgical correction is necessary in cases of complicated aneurysms to prevent distal embolization.

Masson hemangioma is a rare benign vascular tumor characterized by intravascular papillary endothelial hyperplasia (IPEH). Numerous case reports have described lesions in the digits, neck, oral cavity, and intracranially. IPEH involving primary brachial artery aneurysm is extremely rare, with only a handful of reported cases. We present a 43-year-old female with a true distal brachial artery aneurysm who presented with a painful pulsatile mass in the antecubital region. She underwent aneurysm resection and end-to-end repair with a saphenous vein graft. Histology confirmed the diagnosis of IPEH with characteristic features of papillary hyperplasia within the intravascular thrombus.

Our patient exhibited a large tumor on his right upper arm where his former dialysis access site had been. X-ray, Doppler ultrasound, and magnetic resonance imaging scan could not fully reveal the nature of that tumor. Eventually, a surgical approach showed a giant aneurysm of the inflowing brachial artery to a partially obliterated arteriovenous fistula. This case highlights the importance of ongoing care for patients with arteriovenous shunts. Even arteriovenous fistulas, that are obliterated or no longer in use, can, especially when immunosuppressant therapy and other vascular risk factors are added to the overall cardiovascular risk, transform and endanger the health of our patients.

Introduction: Plasmablastic lymphoma is a rare and aggressive neoplasm, generally associated with immunodeficiencies and related to latent Epstein-Barr virus infection. This case is the first reported case of plasmablastic lymphoma relapse in aneurysmatic brachial artery wall. Case description: We describe the case of male patient who underwent cadaveric donor kidney transplant when he was 61 years old and radio-cephalic distal arteriovenous fistula ligation 8 months later. After 8 years, he developed gingival plasmablastic lymphoma treated with cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone regimen with subsequent remission. During follow-up, a mid-forearm vascular access was created because of the worsening of renal function. Twenty-two months later, the patient showed a symptomatic 20 mm brachial artery aneurysm with radiological signs of imminent rupture, for which he was surgically treated. The histological evaluation of the brachial artery specimen revealed a relapse of plasmablastic lymphoma in the arterial wall and in an adjacent lymph node. Conclusion: Brachial artery aneurysms are a rare complication in kidney transplant recipients after ligation of arteriovenous access for haemodialysis. Here, we report a case in which this condition is associated with an even rarer plasmablastic lymphoma. A common aetiology, due to immunosuppressive therapy, is postulated for the two coexisting diseases.

Presented in the article is a clinical case report concerning successful surgical treatment of a rare disease - a progressing congenital true brachial artery aneurysm in a newborn girl. The symptoms were first noted at the age of 7 days, later on followed by enlargement of the aneurysm, appearance of neurological symptoms, and impaired function of the extremity. The infant was subjected to clinical examination and ultrasonographic study, followed by surgical removal of the aneurysm and restoration of the brachial artery by an 'end-to-end' anastomosis. The diagnosis was finally verified only at histological examination. Also contained in the article is a review of the literature underlining that paediatric arterial aneurysms are extremely uncommon, as well as discussing the problems of diagnosis and therapeutic policy. The dilatation of the vessel turned out to be a true aneurysm with all three layers of the vessel in the wall and belonged to the class of paediatric congenital idiopathic arterial aneurysms unassociated with degeneration of the vascular wall or cardiovascular pathology.В статье представлен случай успешного хирургического лечения редкого заболевания - прогрессирующей врожденной истинной аневризмы плечевой артерии у новорожденного ребенка. Симптомы впервые были отмечены в возрасте 7 дней. В дальнейшем было отмечено увеличение размеров аневризмы, появление неврологических симптомов, нарушение функции конечности. Обследование ребенка включало в себя клинический осмотр и ультразвуковое исследование. Выполнена операция удаления аневризмы с восстановлением плечевой артерии анастомозом 'конец в конец'. Окончательно диагноз был верифицирован только при гистологическом исследовании. Представлен обзор литературы, отражающий редкость патологии, проблемы диагностики и лечебной тактики. Расширение сосуда представляло собой истинную аневризму со всеми тремя слоями сосуда в стенке и относилась к классу детских врожденно-идиопатических артериальных аневризм вне связи с дегенерацией сосудистой стенки или сердечно-сосудистой патологией.

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.

Background/Objective: Brachial artery aneurysm (BAA) is a serious complication in patients with previous arterio-venous fistula (AVF), renal transplantation (RT), and immunosuppressive regimens. Until now, there has been no standard of care for these patients, especially for patients undergoing chronic dialysis and immunosuppressive treatment. The aim of this study was to investigate data from the literature regarding these patients and to suggest recommendations for the best approach to their treatment. Methods: A review of the literature was performed by searching the PubMed database in the English language. The review was accompanied by two case reports. A total of 24 articles with different variables—demographics, renal transplantation, aneurysm size, and type of surgery—were subjected to the review. In addition, two cases are reported. Conclusion: This review suggests that the best treatment for these patients is open surgery, with aneurysmectomy and graft interposition. Results: All patients had RT. The age of patients ranged from 26–77 yo, with a male predominance. The majority had an AVF ligated after RT. The main clinical symptoms were pain, swelling, and pulsatile mass (66%). All patients, except one, were treated through open surgery. The first option for treatment was reversed saphenous vein graft interposition (36%), followed by ePTFE graft (16%).

Aneurysmal arterial dilatation is an infrequent complication following arteriovenous fistula ligation. Herein, we are describing a case in which a 49-year-old transplanted patient developed a true, symptomatic, brachial artery aneurysm 25 years after transplantation and 12 years after ligation of his radiocephalic wrist fistula. Treating strategy included aneurysmectomy and reversed vein interposition using ipsilateral, dilated branch of cephalic vein. Two years postoperatively, the patient remains without complications. Moreover, we mention the pathophysiologic mechanisms that may have contributed to this phenomenon.

Behçet’s disease is a vasculitic pathology characterized by skin lesions, genital ulcers, aphthous stomatitis, and uveitis. Arterial aneurysms are rare in this disease. Herein, we report a rare case of an isolated brachial artery aneurysm with a history of Behçet’s disease treated with endovascular covered stenting of the brachial artery.

Introduction The vascular pathology of patients with type 1 neurofibromatosis (NF-1) is known. Aneurysms of the brachial artery in NF-1 patients are rare and surgical treatment remains a challenge. Report A patient known to have NF-1 presented with swelling of the left arm. Computed tomography angiography showed a ruptured aneurysm of the brachial artery. Operative reconstruction was performed using reversed saphenous vein. Discussion Up to now four cases had been published describing brachial aneurysms in NF-1 patients. This case describes the successful reconstruction of a ruptured brachial aneurysm, using a saphenous vein., Highlights • Peripheral aneurysms in type 1 neurofibromatosis are rare. • Surgical reconstruction of a ruptured aneurysm of the brachial artery is challenging. • Successful reconstruction can be achieved with a saphenous vein bypass.

True peripheral artery aneurysms proximal to a longstanding arteriovenous fistula is a well-recognized complication. Late aneurysmal degeneration is rare. This study analyzed the characteristics, therapeutic options, and outcomes of true donor brachial artery aneurysms (DBAA) after arteriovenous fistula (AVF) for hemodialysis. We retrospectively collected the data of patients with DBAA after AVF creation, surgically repaired between January 2001 and September 2015. We excluded patients with pseudoaneurysms, anastomotic aneurysms, and infected aneurysms. We recorded patient's demographics, type of access, aneurysm characteristics, symptoms, treatment, and follow-up. Ten patients were treated for aneurysmal degeneration of the brachial artery. Average aneurysm diameter was 37.5 mm. All cases had, at least, one previous distal AVF, ligated or thrombosed, at the time of diagnosis. The first access was created in mean 137 months before the diagnosis of DBAA. Nine patients had previous medical history of renal transplant and were under immunosuppressive therapy. All patients were symptomatic at the time of diagnosis. In all cases, the treatment was aneurysmectomy followed by interposition bypass. One patient developed a postoperative hematoma with the need of surgical drainage. At 50 months of follow-up, one patient was submitted to percutaneous angioplasty due to an anastomotic stenosis. No other complications occurred during the entire follow-up period (mean: 69 months). The pathogenesis underlying DBAA remains unclear. Increased blood flow after AVF creation, immunosuppressive therapy, and ligation/thrombosis of the AVF may contribute to aneurysm formation. Surgical treatment by aneurysmectomy and bypass, with autogenous conducts, is a safe and effective option.

Introduction Peripheral artery aneurysms are a rare manifestation of Kawasaki disease (KD), with an estimated incidence of approximately 2% of all KD patients. The case of a 14-year-old girl with past clinical history suggestive of KD is reported; she presented with an aneurysm located in the brachial part of a superficial brachioulnoradial artery, still with the genuine brachial artery in place (an anatomical variation with a reported incidence of 0.14–1.3% in general population). Relevant medical data were collected from the hospital database. Report This is a report of a case of a symptomatic superficial brachioulnoradial artery aneurysm, secondary to KD, treated with aneurysm exclusion and superficial brachioulnoradial to the genuine brachial artery transposition. Uneventful intra- and postoperative course with symptom resolution is reported. Discussion The coexistence of a rare manifestation of KD (peripheral aneurysm) with an even rarer brachial artery variation allowed a simple but elegant solution, making this a unique case., Highlights • Peripheral artery aneurysms (PAA) in Kawasaki Disease (KD) are rare (2%). • Although life-threatening coronary involvement is of paramount importance, KD associated PAA may present as limb-threatening conditions. • The correlation between a PAA and KD vasculitis may be difficult to establish if the aneurysm is diagnosed years after the acute phase. • Variations in number and course of upper limb arteries have clinical and surgical importance, as demonstrated in this case.

Background A brachial artery aneurysm (BAA) is a rare condition accounting for 5% of all peripheral arterial aneurysms. More cases of true BAAs after arteriovenous fistula (AVF) closure have been reported in the past two decades. Case presentation A 60-year-old man who underwent AVF closure after renal transplantation had a true BAA on his left elbow that had grown within the past 6 months. We successfully performed an open repair with end-to-end anastomosis. No complications occurred for 1 year. Conclusions High flow due to AVF and some collateral factors such as the use of steroids and immunosuppressants after renal transplantation, arteriosclerosis, and chronic mechanical stimulation might contribute to BAA formation.

True arterial aneurysms of the upper extremity are rare. The case described is that of a 48-year-old man presenting with median neuropathy and distal vascular compromise 4 years after ligation of a brachiocephalic arteriovenous fistula. We describe our approach and present a review of the relevant literature.

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.

Brachial artery (BA) aneurysms are rare, and most are false aneurysms. Although true BA aneurysms have been reported, most have been reported without symptoms. A 65-year-old man was referred due to a left upper limb mass with rest pain and slight ulceration of the left second and third fingers. As enhanced computed tomography revealed the patency of only the left proximal and distal BA as well as the thrombosed mass, excision of the aneurysm and BA replacement were performed with a great saphenous vein graft. The postoperative course was uneventful, and the rest pain and ulceration were resolved.

True aneurysm of the brachial artery is a rare disease entity. The mechanism of aneurysm formation is considered to be compression of the arterial wall, producing contusion of the media and subsequent weakness of the wall and fusiform dilatation. It can be caused by arteriosclerotic, congenital, and metabolic disorders, and can be associated with diseases such as Kawasaki's disease. Doppler ultrasonography, computed tomography, arteriography, and selective upper extremity angiography may be performed for establishing the diagnosis of aneurysm. The best therapeutic option is operative repair, and it should be performed without any delay, in order to prevent upper extremity ischemic or thrombotic sequelae. Here, we report a case of recurrent brachial artery aneurysm with review of the literature.