Surgical management of an isolated symptomatic true axillary artery aneurysm

A 72-year-old male, with no medical history, presented with acute ischemia of the second and third digits of his left hand (acute limb ischemia classification 1) to our emergency department. Radial and ulnar arterial pulses were palpable at physical examination. Symptoms improved during his admission to the emergency department and the digits remained viable. The patient denied any history of trauma or use of crutches.

Duplex ultrasound and a computed tomography angiogram showed a left axillary artery aneurysm containing a thrombus with a maximum diameter of 3.7 cm (Panel A; arrows) as the embolic source. Semi-elective surgical management of the symptomatic aneurysm was recommended to prevent further embolic complications of the distal arm. The aneurysm was considered unsuitable for endovascular intervention due to the artery’s tortuous course. Using an incision distal to the lateral clavicle, the aneurysm was exposed by splitting the major and division of the minor pectoral muscles. The aneurysm originated distally to the acromiothoracic artery (Panel B; arrow) and lay in close relation to the lateral cord of the brachial plexus. There were no signs of inflammation or infection. Following resection of the aneurysm, circulatory continuity was re-established using a great saphenous vein interposition graft (Panel C; arrow). Two days after surgery the patient was discharged without complications and with a well-perfused, pain-free left hand.

Panel A Panel B Panel C

True aneurysms of the axillary arteries are extremely rare and are mainly reported secondary to repetitive compression or stretching of the axillary artery in overhead-throwing athletes (arterial thoracic outlet syndrome spectrum), with the use of crutches, and in patients with connective tissue disease.^1,2 Symptoms can include circulatory and neurological impairment of the distal limb, though a high degree of suspicion remains a prerequisite for diagnosis. Both surgical and endovascular management have been described. ³ In this case, surgical management was successfully performed, thereby preventing further thromboembolic events.

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