Management of brachial artery aneurisms in infants

Fondation Lenval, Nice, France.
Pediatric Surgery International (Impact Factor: 1). 05/2008; 24(4):509-13. DOI: 10.1007/s00383-007-2069-5
Source: PubMed


Brachial artery aneurisms in children under 1 year of age are very rare. The main risk is distal ischaemic complication. We report four infants suffering from brachial artery aneurism of unknown origin. In all cases we used Doppler ultrasonography to validate the clinical diagnosis. Pre-operative vascular check-up was negative for other aneurismal location. Surgical excision with direct end-to-end anastomosis was possible in one patient; the others required interposition of an autologous venous graft. At discharge, patients were given oral aspirin for a few weeks. Histological examination revealed one pseudoaneurism and three true aneurisms. There were no complications either postoperatively or at 18 months follow-up. Arterial ligation might be indicated in only two situations: aneurism distal to profunda brachii artery, or chronic wall thrombus completely occluding (but distal perfusion through a neovascularization must be assessed first on angiography). Surgical excision with arterial reconstruction is the standard treatment. Endovascular treatment is not suitable because such a procedure in an infant would generate excessive radiation exposure, and a risk of stent migration with limb growth. In the case of an initial isolated and idiopathic presentation, or of false aneurism, clinical follow-up at 1 year is sufficient. In the case of secondary lesion, multiple initial presentation or relapse, life-long follow-up with repeated corporal imaging should be performed.

4 Reads
  • Source
    • "Although a single small pseudoaneurysm that is located distal to the brachial bifurcation can be ligated [25], surgical excision with arterial reconstruction is the standard treatment. The arterial continuity should be restored with end-to-end anastomosis or a venous interposition graft [20,27]. Endovascular stent-grafts implantation is a minimally invasive intervention with a high success rate. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A brachial artery pseudoaneurysm is a rare but serious condition that can be limb threatening. A number of reports have found that it may be the result of damage to the blood vessels around the brachial artery, either directly or indirectly, due to trauma or systemic diseases. We present our experience of delayed pseudoaneurysm rupture of the brachial artery in a rehabilitation patient with burns of the upper extremity who underwent fasciotomy and musculocutaneous flap coverage. We also provide a review of the brachial artery pseudoaneurysm.
    Full-text · Article · Jun 2013 · World Journal of Emergency Surgery
  • Source
    • "Although angiographic embolization is quite reliable and safe method, neurological complication or soft tissue necrosis related with destruction of existing vascular lesion or reflux of embolization material had been reported [22, 23]. The last option of treating the pseudoaneurysm is the surgical exploration and the removal of the lesion, especially when the lesion is located superficially and directly accessible [3] or the excessive radiation exposure is discouraged in growing children [24]. Therefore, we suggest pathway of the management for pseudoaneurysm as follows; interventional radiology as the first-line treatment and surgical approach as secondary option especially for the aforementioned indications. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Pseudoaneurysms are caused by rupture of arteries with extravasation of blood. The compressed perivascular tissue forms the wall of aneurysmal sac. Pseudoaneurysm directly related with surgical procedure of sagittal split ramus osteotomy (SSRO) was reported quite rarely especially related with facial artery during the vertical osteotomy. Case report SSRO was carried out for a 19-year-old male; the patient visited the emergency room with notable swelling 3 weeks after the surgery. We experienced severe intra-oral bleeding with surgical exploration. Angiography revealed a pseudoaneurysm of the right facial artery that might be related with vertical osteotomy over lateral cortex of the mandibular body during orthognathic surgery. This implies that the minor vascular trauma from vertical osteotomy of the mandibular body during the conventional orthognathic surgery might cause later development of pseudoaneurysm.
    Full-text · Article · Aug 2012 · Oral and Maxillofacial Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: A model for design representation and levels of abstraction which distinguishes between the various types of levels of synthesis systems is reviewed. The SilcSyn application-specific integrated circuit (ASIC) design system, a synthesis system combining high-level behavioral design, architectural synthesis and optimization, and logic synthesis and optimization, is described. How SilcSyn fits into a total ASIC design environment is shown. That automatic design for testability is a requirement of any synthesis system is proposed, and SilcSyn's method for assuring a high degree of testability is described. An example of an ASIC designed with SilcSyn is presented
    No preview · Conference Paper · Nov 1989
Show more