Infected upper extremity aneurysms: a review.

OBJECTIVES To review the occurrence of mycotic aneurysm affecting upper extremity arteries. DESIGN Literature review. MATERIALS AND METHODS A MEDLINE search from 1950 until 2007 and an extensive manual search were carried out using bibliographies from relevant published papers including cases involving arteries distal to the subclavian. RESULTS A total of 149 cases (68 papers) were identified. The brachial artery was the most frequently reported site, mostly associated with drug abuse, catheterization procedures or endocarditis. Since 1950 arterial trauma (drug abuse or catheterization) was the commonest cause. Gram positive organisms were the most frequent microbes involved. Acknowledging a limited follow-up, most patients did well when surgical therapy was promptly instituted. CONCLUSIONS Infected upper extremity aneurysms have been rarely described. IV drug abusers are a unique high-risk group for mycotic aneurysms in the upper extremities, most importantly in the axillary and brachial arteries. When rapidly performed, arterial ligation, primary repair or reconstruction with autogenous conduits was associated with favorable outcomes.