Antonescu Ioana, McGinigle Katharine L, Crowner Jason R
Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
J Vasc Surg Cases Innov Tech. 2018 Dec 10;4(4):335-338. doi: 10.1016/j.jvscit.2018.08.010. eCollection 2018 Dec.
Dilation throughout the brachial artery in the setting of an arteriovenous fistula is a common occurrence, but focal aneurysmal dilation is not often visualized. Progressive enlargement of a focal arterial segment warrants intervention before negative sequelae. We present the case of a 38-year-old man with history of left upper extremity brachiocephalic fistula who had an enlarged brachial artery and progressive aneurysmal dilation of the distal aspect after ligation and excision of a dilated venous outflow component. The patient was successfully treated with resection and end-to-end reconstruction of the brachial artery, with resolution of pain and improvement in the functionality of his extremity. This case highlights the possible challenges encountered in such situations, when the anatomy is so distorted that it is difficult to clearly delineate on preoperative imaging.
在动静脉瘘的情况下，肱动脉全程扩张是常见现象，但局灶性动脉瘤样扩张并不常被发现。局灶性动脉节段的进行性扩大在出现不良后果之前需要进行干预。我们报告一例38岁男性病例，该患者有左上肢头臂瘘病史，在结扎并切除扩张的静脉流出道成分后，肱动脉增粗且远端出现进行性动脉瘤样扩张。该患者通过肱动脉切除及端端重建成功治愈，疼痛缓解，肢体功能改善。该病例突出了在这种情况下可能遇到的挑战，即解剖结构严重扭曲，术前影像学难以清晰界定。
