ABSTRACT
A 67-year-old male of Egyptian descent presented to the vascular outpatient clinic with a left lower limb pulsating mass in the mid-inner thigh region. A computed tomography angiography (CTA) revealed a 3x4cm left mid-superficial femoral artery (SFA) aneurysm and a 2x3cm aneurysm in the right mid-SFA. An open repair of the left, followed by right SFA aneurysms, was performed in a sequential matter, six weeks apart. The patient's recovery and follow-up were uneventful. Pathology revealed both specimens to be true atherosclerotic aneurysms. This is a case report of a true bilateral SFA aneurysm.
ABSTRACT
INTRODUCTION AND IMPORTANCE: True ulnar artery aneurysms are a rare entity, with existing literature suggesting that most of these aneurysms are due to trauma. This case report sheds light on a true ulnar artery aneurysm that was deemed to be idiopathic. CASE PRESENTATION: A 49-year-old lady presented with numbness in the medial 3 fingers of the left hand, tenderness over the medial forearm, and a palpable ulnar artery pulse. There was no history of trauma. An arterial ultrasound, MRI of the forearm, and upper limb angiography confirmed the diagnosis of ulnar artery aneurysm. Surgical repair of the aneurysm was done with excellent immediate post-operative and follow up results. CLINICAL DISCUSSION: Trauma is the most common cause for the development of ulnar artery aneurysms. In this case however, after detailed history taking, physical examination, and thorough investigations, the cause of the patient's aneurysm was deemed to be idiopathic. Treatment of ulnar aneurysms are not well established due to the rarity of the disease. A surgical approach however may be considered depending on the location of the aneurysm along with the patient's symptoms. CONCLUSION: A high index of suspicion, thorough history, physical examination, and appropriate investigations are required to diagnose ulnar artery aneurysms. Surgical intervention is indicated to relieve symptoms of nerve compression and prevent limb threatening ischemia. Regular post-operative follow up is essential to detect potential graft dysfunction and to ensure a good outcome.
ABSTRACT
Outflow venous obstruction is a common problem in patients with autogenous upper extremity hemodialysis access. Surgical revision to divert blood flow into the patent vein is sometimes possible to restore unobstructed flow. The result of this type of procedure is not yet well known. The purpose of this report is to describe our experience with outflow venovenostomy (VV) to salvage dysfunctional autogenous upper extremity arterial venous access (AVF) threatened by venous outflow obstruction in hemodialysis-dependent patients. All patients who underwent VV procedures between September 1999 and October 2004 were reviewed. Data regarding patient demographics, comorbidities, procedure indications, perioperative complications, as well as postoperative AVF function and patency were gathered from patient charts and dialysis records. A total of 11 patients underwent VV in the study period. The median age of the AVF prior to VV was 14 months, with a range of 4-45 months. Two patients had radial cephalic AVF, and they had VV done in the antecubital fossa. Nine patients had brachial cephalic AVF. Seven of them underwent cephalic vein transposition VV, while two patients had basilic vein transposition. Functional AVF was achieved after 1 month in 10 out of 11 patients. Five patients had no further access interventions, four patients required angioplasty at the VV site to maintain access function, and one patient had access infection requiring surgical revision during follow-up. One patient never achieved access function. Postintervention assisted functional patency was 90% +/- 9.5% at 39 months. Median follow-up after VV was 16 months. Outflow VV is a viable surgical option for selected patients with failing AVF due to venous outflow obstruction.