A 59-year-old female presented with enlargement of her entire right upper extremity, accompanied by dilated superficial veins, which were present since her early childhood (A/Cover). Recently, she felt increasing swelling with pain, and she denied any history of trauma or interventions involving the limb. Physical examination showed a warm and hypertrophic limb with several abnormal vessels clearly evident on the surface. She underwent a computed tomographic angiography (CTA) with three-dimensional reconstruction, which demonstrated not only a 20 mm × 25 mm proximal radial artery aneurysm (B, star) but also multiple arteriovenous malformations (AVMs) between branches of the arterial and venous in the right upper extremity. Meanwhile, the brachial artery (B, white arrow), the arterialized cephalic vein (B, red arrow), and brachial vein (B, blue arrow) could be seen clearly. However, no AVMs were found in other parts of the body. Considering her aggravated symptoms, embolization and sclerotherapy were planned, but the patient refused any further treatment.
Radial arterial aneurysm occurs very rarely. The etiology can be classified into congenital, mechanical, traumatic, infectious, degenerative, and anastomotic.1 AVMs of upper extremities are also uncommon. Potential causes include congenital anomalies, surgically created access for hemodialysis treatment, or pathological processes, such as trauma, neoplasm, or infection of the vulnerable portion of the arteriovenous wall. Clinical presentations include heaviness, a pulsating mass, sensation of heat, pain, bleeding, ulceration, and necrosis.2 Treatment is considered only when the benefits exceed the risks. However, there are not yet any established guidelines for the treatment of upper extremity AVMs. A multidisciplinary approach, which integrates endovascular and surgical therapies, has been promoted as a promising therapeutic modality with good results in early follow-up.2,3
Disclosures
None.
Footnotes
The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.
Appendix
Cover image.
References
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