Upper Extremity Arterial Aneurysm of Humeral Branches or Forearm Arteries with Confirmed Collateral Circulation

Clinical Scenario

This protocol addresses upper extremity arterial aneurysms involving the humeral branches — the anterior or posterior circumflex humeral artery — or the forearm arteries (ulnar, radial, or interosseous artery), in cases where sufficient collateral circulation and distal blood supply have been confirmed through Allen's test, plethysmography, and perioperative backflow assessment.

Why Collateral Assessment Is Central

These vessels are not terminal branches. The existence of adequate collateral vascularisation is the determining factor for the surgical approach chosen. A thorough preoperative work-up — duplex ultrasound, CTA or MRA, and functional tests including Allen's test or plethysmography — is required before treatment planning. Perioperative backflow assessment further confirms feasibility at the time of surgery.

Surgical Approach (Overview)

When collateral blood supply is demonstrated to be sufficient, the surgical management involves open resection of the aneurysm. The complete evidence-based regimen — including full eligibility criteria, procedural details, and the structured clinical algorithm — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

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.
Resection without revascularization has the advantage to avoid complications such as pseudoaneurysm and longer operative time.

View source ↗