Idiopathic true brachial artery aneurysm in an 18-month-old girl

An 18-month-old girl was transferred to our university hospital for the management of a 12-mm brachial artery aneurysm found by her mother while the child was being bathed. The patient had had an uneventful vaginal delivery, had met all milestones, and there was no evidence or history of physical trauma. No dysmorphic physical attributes were identified on careful examination. There was also no family history of childhood illnesses, aneurysmal disease, or rheumatic or connective tissue diseases. A whole-body computed tomography angiography demonstrated the partially thrombosed left brachial artery aneurysm with a well-developed profunda brachial artery (A; Cover). There werenootherectatic, aneurysmalor tortuousarteries.Resultsof complete laboratoryassessments, including standard rheumatologic assays were all negative. The lack of long-term data supporting ligation of such an aneurysm vis-a-vis extremity growth and the minimal morbidity of vein bypass in this setting prompted the family to consider brachial artery reconstruction. Preoperativegreat saphenous veinmappingdemonstratedvenousdiametersof15mmin the thighs. The patient was taken to the operating room for brachial artery excision and reconstruction with vascular and microvascular surgical teams. A great saphenous vein segment was isolated from the left thigh while the aneurysm was exposed (B) and controlled with microvascular clips (C). Aneurysmectomy and reconstruction with reversed great saphenous vein sewn end-to-end with 9-0 interrupted nylon suture was performed (D), similar to the description of other reports. An excellent graft Doppler signal and palpable pulses at the wrist were present at the conclusion of the procedure. Final pathology, shown as a cross-sectional image of the brachial aneurysm with elastin stain (E), revealed a true aneurysm with extensive thrombus and florid fibrointimal proliferative ingrowth without evidence of infection or arteritis.