- Incidence and Causes:
- Axillary artery aneurysms are rare, most often associated with traumatic arterial injuries (acute or chronic). Other causes include atherosclerosis, arteritis, connective tissue disorders, congenital factors, or idiopathic etiologies.
- Presentation:
- Often asymptomatic, presenting as a pulsatile axillary mass.
- Symptoms may include arm pain or dysfunction due to distal embolization or nerve compression.
- Rupture is rare but possible.
- Diagnosis:
- Physical Exam
- Palpation of the infraclavicular or axillary region to detect masses; evaluation of the arm and hand for distal embolization signs.
- Imaging
- Ultrasound is the primary diagnostic tool. CT or MR angiography aids in diagnosis and surgical planning. Digital subtraction angiography (DSA) is used selectively for evaluating distal arterial runoff.
- Management
- Indications for Repair:
- Symptomatic aneurysms or Asymptomatic aneurysms that are twice the diameter of the normal artery.
- Surgical Repair:
- Open surgical repair with interposition grafting.
- Preferred approach:
- Care is required due to proximity to the brachial plexus.
- Conduits:
- Prosthetic for large arteries and short repairs.
- Autogenous vein grafts for small arteries and long repairs.
- Endovascular Repair:
- Less common due to motion and compression of the axillary artery.
- Reserved for focal aneurysms, palliation, or bridging in acute settings.
- Covered self-expanding stents are used to avoid external compression.