# Surgical Treatment of a Giant Proximal Ulnar Artery Aneurysm Potentially Associated With Subacute Endocarditis

## TL;DR

A rare case of a large ulnar artery aneurysm is described, highlighting the importance of thorough diagnosis and the potential link to subacute endocarditis.

## Contribution

The case emphasizes the need for heightened suspicion and the use of transesophageal echocardiography in diagnosing endocarditis associated with upper-limb aneurysms.

## Key findings

- A giant proximal ulnar artery aneurysm was successfully treated with aneurysmal exclusion and saphenous vein graft interposition.
- Endocarditis diagnosis was confirmed via transesophageal echocardiography despite negative initial tests.
- Microbiological cultures and TTE have limited sensitivity for diagnosing infective endocarditis.

## Abstract

Ulnar artery aneurysms (UAAs), although infrequent, pose limited challenges in terms of timely diagnosis and surgical intervention. Their intricacy lies in discerning and addressing the underlying pathology, often necessitating prolonged hospitalization. Herein, we present a case detailing a giant aneurysm located in the proximal ulnar artery, measuring 5.2 cm in diameter. The patient exhibited negative microbial cultures and non-pathological transthoracic echocardiography (TTE). Successful treatment involved aneurysmal exclusion and saphenous vein graft interposition. While the initial microbiological cultures and TTE yielded negative results, the diagnosis of endocarditis was ultimately confirmed through a subsequent transesophageal echocardiography (TEE) examination. This case report underscores the imperative for heightened clinical suspicion when confronted with upper-limb aneurysms. The diagnostic process necessitates sustained diligence for identifying the underlying pathology, a task that, in certain instances, requires prolonged hospitalization. Both microbiological cultures and TTE have exhibited diminished sensitivity in the diagnosis of infective endocarditis and should consistently be complemented by TEE.