Aneurysms of the upper limb

ABSTRACT

Fiftyone aneurysms of the upper limb were studied prospectively in a four-year period between 1986 and 1990, in the Department of Vascular Surgery of Dow Medical College and Civil Hospital, Karachi. Most of these aneurysms had resulted from penetrating trauma and the majority of patients [98%] underwent angiography and operative treatment within one year of onset. The urban setting and criminal violence were the main reasons for male preponderance [92%]. Distal subclavian and Axillary arteries were most commonly involved, revealing a pulsatile lump in the majority [80%] of the patients. Most of these vascular injuries were associated with neurological trauma [68.6%] and the resultant decrements were produced by nerve divisions [57%] and neuropathy [43%]. Excision of the aneurysm and long saphenous vein interposition graft was the commonest procedure [82%] used. Patency rate of the anastomotic conduit was 96% at six weeks. This was an excellent result. Unfortunately poor reattendance of the patients at subsequent follow-ups has resulted in a great unreliability of this patency rate. Lack of education, lack of awareness and poor compliance were the main causes of failure to reattend after such a major injury and salvage, and it is hoped that in the future more of these patients can be traced to determine the outcome of the management