AbstractAneurysms of collateral arteries are unusual. A case of transverse cervical artery aneurysm as the sole presentation of vascular thoracic outlet syndrome is presented and the relevant literature reviewed

Agarwal, S.

Lee, A.D.

Nayak, S.

Perakath, B.

Shyamkumar, N.K.

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Collateral Artery Aneurysm: A Unique Presentation of Thoracic Outlet Syndrome 

CASE REPORT* Correspond
General and
Hospital, Vel
E-mail address
1078–5884/00Collateral Artery Aneurysm: A Unique Presentation of
Thoracic Outlet Syndrome
A.D. Lee,1* N.K. Shyamkumar,2 S. Nayak,1 S. Agarwal1 and B. Perakath1Departments of 1General Surgery, and 2Radiology, Christian Medical College, Vellore, IndiaAneurysms of collateral arteries are unusual. A case of transverse cervical artery aneurysm as the sole presentation of
vascular thoracic outlet syndrome is presented and the relevant literature reviewed.Keywords: Artery; Aneurysm; Thoracic outlet syndrome.Collateral artery aneurysms are uncommon. Apart
from posing unique management challenges these
lesions also lend support to the biomechanical theory
of aneurysm formation. We report an aneurysm of the
right transverse cervical artery, which was a major
collateral to an occluded subclavian artery due to
thoracic outlet syndrome.Case Report
A 67-year-old lady, presented with a 1-year history of a
pulsatile swelling in the right supraclavicular fossa.
She was otherwise asymptomatic. Her right radial and
ulnar pulses were weaker than the left. Chest radio-
graph did not show a bony cervical rib. Digital
subtraction angiography revealed, total occlusion of
the second part of the right subclavian artery, with
distal reformation through a grossly hypertrophied
right transverse cervical artery. There was an aneur-
ysm, partially filled with thrombus, arising from the
transverse cervical artery (Fig. 1).
At operation, she was found to have a prominent
scalene tubercle with a fibrous band compressing the
subclavian artery. She underwent a scalenotomy,
excision of the aneurysm and end-to-end anastomosis
of the collateral artery. In view of her age and gooding author. Dr Arvind Dhas Lee, MS, Department of
Vascular Surgery Unit 2, Christian Medical College
lore, India.
: arvindlee@yahoo.com
0611+ 02 $35.00/0 q 2005 Elsevier Ltd. All rights reservlimb perfusion, subclavian artery bypass was not
performed. Postoperative recovery was uneventful.
Histopathological examination of the excised speci-
men showed aneurysm wall formed by hyalinizedEur J Vasc Endovasc Surg 29, 611–612 (2005)
doi:10.1016/j.ejvs.2005.02.015, available online at http://www.sciencedirect.com onFig. 1. DSA of the right subclavian artery showing total
occlusion of the 2nd part of the subclavian artery (arrow) and
the partially filling aneurysm (arrow head) arising from the
hypertrophied transverse cervical artery (curved arrow).
ed.
A. D. Lee et al.612fibrocollagenous tissue and smooth muscle fibres
enclosing a recanalising thrombus. At 1-year follow
up she continued to be asymptomatic and her radial
pulse was palpable.Discussion
Arterial occlusion due to thoracic outlet syndrome
often remains asymptomatic because of a rich collat-
eral circulation in the upper limb. Symptomatic cases
usually present with features of distal thrombo-
embolism and ischaemia. Rarely, they can present
with a pulsatile neck mass due to a subclavian artery
aneurysm. The case presented above was unique in
that, the collateral artery aneurysm was the sole
presentation of the vascular thoracic outlet syndrome.
Collateral arterial aneurysms or flow-related aneur-
ysms have been infrequently reported in world
literature. The extra-cranial sites in which these
aneurysms have been described include, inter-ver-
tebral collaterals,1 intercostal artery2 and radial col-
lateral artery.3 Interestingly, there have been no reports
of these aneurysms occurring in the lower limbs,
probably reflecting the relative paucity of collateral
circulation in the lower limbs as compared to the
upper limbs and neck. Apart from the role of high flow
in the pathogenesis of these lesions, their significanceEur J Vasc Endovasc Surg Vol 29, June 2005lies in their management. Angiography remains the
gold standard to delineate the arterial occlusion and
delineate the collaterals. Correction of the underlying
obstruction may be needed to avoid recurrence. In the
above case, the unusually large and tortuous collateral
permitted an end-to-end anastomosis without resort-
ing to bypass grafting.
This case is reported in order to emphasize the need
to recognize the occurrence of flow-related aneurysms.
The theoretical risk of developing these lesions
following therapeutic embolization or ligation of
non-essential arteries must be borne in mind.References
1 Pasco A, Papon X, Fournier D, Mercier P, Caron-Poitreau C,
Enon B. Subclavian steal syndrome and flow-related aneurysm.
Another reason to treat. J Cardiovasc Surg (Torino) 1999;40(2):265–
269.
2 Erdal AC, Silistreli E, Karabay O, Acikel U. Asymptomatic
aortic coarctation associated with loss of luminal continuity and
intercostal artery aneurysm. J Cardiovasc Surg (Torino) 2004;
45(1):93–94.
3 Khatri VP, Amin AK, Fisher JB. Radial artery collateral
aneurysm: a rare entity resulting from an unusual etiology. Ann
Vasc Surg 1992;6(6):530–532.
Accepted 10 February 2005
Available online 28 March 2005


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Collateral Artery Aneurysm: A Unique Presentation of Thoracic Outlet Syndrome

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