- Incidence
- Extremely rare, primarily caused by trauma.
- Cause
- Commonly associated with pseudoaneurysms due to:
- Dialysis access (current or former arteriovenous fistulas).
- Illicit drug injections.
- Other causes: connective tissue disorders, atherosclerosis, infection, congenital factors, or idiopathic origins.
- Presentation:
- Typical finding: Pulsatile mass, either asymptomatic or symptomatic.
- Symptoms:
- Pain, numbness, paresthesias.
- Sensorimotor deficits in the median nerve distribution (digits 1–3).
- Ischemic symptoms from peripheral emboli (forearm, hand, fingers).
- Rupture: Rare but possible, particularly in pseudoaneurysms from drug injection.
- Diagnosis:
- Physical Exam: Pulsatile mass in the medial upper arm; assess for distal ischemia (pulse examination, signs of embolization, nerve compression).
- Imaging:
- Duplex ultrasound for initial evaluation.
- CT/MR angiography for thrombus identification and inflow/outflow assessment.
- Digital subtraction angiography for operative planning, particularly to evaluate distal runoff.
- Management
- Indications for Repair:
- Symptomatic aneurysms.
- Asymptomatic aneurysms twice the diameter of the adjacent artery.
- Surgical Repair:
- Preferred approach: Open surgical repair.
- Techniques:
- Focal aneurysms: Resection with primary repair.
- Most cases: Interposition bypass graft, usually with an autogenous conduit (preferred due to durability) or prosthetic conduit if necessary.
- Endovascular Repair:
- Limited use due to risks of stent fractures (superficial location and frequent artery flexion).
- Best suited for pseudoaneurysms, particularly at dialysis access sites.
- Durability is less favorable compared to surgical repair.