Kuntz Salomé, Lejay Anne, Georg Yannick, Thaveau Fabien, Chakfé Nabil
Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France.
Int Angiol. 2020 Apr;39(2):161-170. doi: 10.23736/S0392-9590.20.04307-2. Epub 2020 Feb 12.
The aim of this paper is to provide recommendations for diagnosis and management of arterial or venous aneurysms of the upper extremity.
A systematic review of the Medline and Cockrane databases was performed from 1988 to 2019 by a combined strategy of MeSh terms.
One-hundred-forty-four publications were identified: 111 addressing arterial aneurysms and 33 addressing venous aneurysms. A total of 162 cases of arterial aneurysms, mostly brachial aneurysms (34.0% of cases) and 40 cases of venous aneurysms, mostly located in the forearm (60.0% of cases) were reported. For both types of aneurysms, most common presentation was the perception of a mass (56.3% for arterial one and 87.5% for venous one), but thromboembolic complication (46.7%), paresthesia (16.5%) or rupture (6.4%) could be observed in the setting of arterial aneurysms, while arm swelling (27.5%), neurological symptoms (12.5%), pulmonary embolism (10.0%) or rupture (2.5%) could occur in the setting of venous aneurysms. DUS was performed as first imaging modality for both settings, followed but CTA and MRA, especially in arterial aneurysms, to evaluate distal emboli and surrounding vasculature. Surgical treatment was mostly based on excision of the aneurysms with revascularization for arterial aneurysms (77.2%) and resection without reconstruction for the venous one (85.0%). Complications occurred in 10.5% of the cases of arterial aneurysms, none occurred after venous aneurysm resection.
Prompt diagnosis and appropriate preoperative imaging are mandatory in order to offer the best treatment modality. Open resection with revascularization seems to be the treatment of choice for arterial aneurysms, although endovascular procedures became more popular. Venous aneurysms require excision without revascularization.
本文旨在为上肢动脉或静脉动脉瘤的诊断和管理提供建议。
通过医学主题词（MeSh）术语的联合策略，对1988年至2019年的Medline和Cockrane数据库进行了系统综述。
共识别出144篇出版物：111篇涉及动脉动脉瘤，33篇涉及静脉动脉瘤。共报告了162例动脉动脉瘤病例，其中大多数为肱动脉瘤（占病例的34.0%），40例静脉动脉瘤病例，大多数位于前臂（占病例的60.0%）。对于这两种类型的动脉瘤，最常见的表现是摸到肿块（动脉动脉瘤为56.3%，静脉动脉瘤为87.5%），但在动脉动脉瘤的情况下可观察到血栓栓塞并发症（46.7%）、感觉异常（16.5%）或破裂（6.4%），而在静脉动脉瘤的情况下可能发生手臂肿胀（27.5%）、神经症状（12.5%）、肺栓塞（10.0%）或破裂（2.5%）。对于这两种情况首先都采用超声多普勒（DUS）作为成像方式，其次是CTA和MRA，特别是在动脉动脉瘤中，以评估远端栓子和周围血管系统。手术治疗主要基于切除动脉瘤，动脉动脉瘤进行血管重建（77.2%），静脉动脉瘤则进行无重建的切除（85.0%）。动脉动脉瘤病例中有10.5%发生并发症，静脉动脉瘤切除术后无并发症发生。
为了提供最佳治疗方式，必须进行及时诊断和适当的术前成像。尽管血管内手术越来越普遍，但开放切除并血管重建似乎是动脉动脉瘤的首选治疗方法。静脉动脉瘤需要进行无血管重建的切除。
