Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, 28033Pontificia Universidad Católica de Chile, Santiago, Chile.
Vasc Endovascular Surg. 2022 Aug;56(6):622-627. doi: 10.1177/15385744221095668. Epub 2022 May 2.
The objective of this study is to report a case of a 65-year-old woman who presented with pallor and pain of her left arm secondary to a true arterial brachial aneurysm, which was successfully treated with saphenous vein bypass and embolization of the aneurysm sac. A review of the literature is also presented. A 65-year-old woman presented with an acute onset of pallor and pain of her left forearm, and hand. On physical examination, there was a pulsatile mass at the forearm. A doppler ultrasound showed a fusiform aneurysmal dilatation of the brachial artery of 23 mm of diameter. A dynamic contrast-enhanced MRI angiogram confirmed a fusiform dilation of the distal brachial artery. The patient was scheduled for open repair. A fusiform 20 x 60 mm aneurysm of the distal brachial artery extending to the cubital fossa was found and a brachial artery to radial and ulnar arteries bypass with interposed reverse right saphenous vein was created. Embolization of the aneurysm sac was performed using Gelita-spon ® (Gelita Medical, Eberbach, Germany). A final angiogram showed an adequate perfusion through the bypass to the hand, and no contrast in the aneurysmal sac. Postoperative course was uneventful with discharge on the fourth postoperative day. Revascularization with autologous saphenous vein graft and exclusion of the aneurysm with local embolization is a good treatment alternative in a patient with symptomatic brachial aneurysm with distal embolization.
本研究旨在报告一例 65 岁女性病例，其因真性肱动脉动脉瘤导致左臂苍白和疼痛，通过隐静脉旁路和动脉瘤囊栓塞成功治疗。本文还回顾了相关文献。 一名 65 岁女性因左前臂和手部突发苍白和疼痛而就诊。体格检查时，前臂有一搏动性肿块。多普勒超声显示肱动脉呈梭形动脉瘤样扩张，直径 23 毫米。动态对比增强 MRI 血管造影证实了远端肱动脉的梭形扩张。患者计划进行开放修复。发现远端肱动脉有一个 20 x 60 毫米的梭形动脉瘤，延伸至肘窝，并进行肱动脉至桡动脉和尺动脉旁路，中间插入反向右侧隐静脉。使用 Gelita-spon ®（Gelita Medical，Eberbach，德国）对动脉瘤囊进行栓塞。最终的血管造影显示旁路到手部的灌注充足，动脉瘤囊中无造影剂。术后恢复顺利，第四天出院。 在有症状的肱动脉瘤伴远端栓塞的患者中，自体隐静脉移植再血管化和局部栓塞动脉瘤是一种很好的治疗选择。
