This protocol addresses upper extremity arterial aneurysm arising in the humeral branches — anterior or posterior circumflex humeral artery — or in the forearm arteries (ulnar, radial, or interosseous artery), specifically when preoperative and perioperative assessment reveals insufficient collateral circulation and blood supply.
Because these vessels are not terminal branches, the adequacy of collateral blood flow determines the operative approach. A complete preoperative work-up — using Allen's test, plethysmography, and imaging (DUS, CTA, or MRA) — is required to evaluate whether resection alone is feasible. Collateral backflow is also assessed perioperatively. When these evaluations confirm insufficient collateral supply, a different management strategy applies.
When collateral circulation is deemed insufficient, open surgical resection of the aneurysm is indicated — and revascularization is required as part of the procedure. The complete operative strategy is available in the full protocol.
DOI: 10.23736/S0392-9590.20.04307-2
Humeral branches (anterior and posterior circumflex humeral arteries) and forearm arteries (ulnar, radial and interosseous arteries) are not terminal branches and the existence of collateral vascularization and therefore collateral blood flow might allow a resection without revascularization in these territories.
A complete preoperative work-up is necessary to assess the feasibility of a resection without revascularization (DUS, CTA or MRA and by using Allen's Test or plethysmography) and perioperatively by assessing of backflow of the vessel.
Optimal treatment is still unknown, but surgical resection with revascularization using a venous substitute was the most frequent treatment in the setting of arterial aneurysm.
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