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van Embden D, Rhemrev SJ. [A woman with a painful shoulder and cold hand]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2010; 154:A791. [PMID: 20619030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 65-year-old woman presented with a left-sided humeral fracture and a cold hand, caused by a dissection of her axillar artery. She was treated conservatively and perfusion recovered spontaneously.
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27
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Gverić T, Ivkosić A, Trajbar T, Huljev D, Nadinić V, Barisić J, Skok I, Gverić-Ahmetasević S, Barić M. [Trauma of the brachial plexus and associated vascular injury--a case report]. LIJECNICKI VJESNIK 2009; 131:306-308. [PMID: 20143599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Acute vascular trauma in the axillary region is usually associated with brachial plexus injury and presents a great challenge to surgeon and formidable obstacle to restore a useful limb function. Interdisciplinary operative and postoperative approach is mandatory providing an optimal care of these severe patients. Here we present a case of neurovascular trauma that affected axillary artery and vein, complete transection associated with complete transection of the brachial plexus. Immediately after admission emergency surgery was performed and in postoperative follow up, after several operations and rehabilitation that continued for 24 months, entire functional recovery was achieved without any disabling consequences.
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Kumar RM, Reddy SS, Sharma R, Mahajan R, Talwar KK. Endovascular repair of a traumatic axillary artery pseudoaneurysm. Cardiovasc Intervent Radiol 2009; 32:598-600. [PMID: 19296160 DOI: 10.1007/s00270-009-9543-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Revised: 12/28/2008] [Accepted: 01/06/2009] [Indexed: 11/26/2022]
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29
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Inui A, Kokubu T, Fujioka H, Toyokawa N, Nakagiri K, Doita M, Kurosaka M. Shoulder fracture dislocation associated with axillary artery injury: a case report. J Shoulder Elbow Surg 2008; 18:e14-6. [PMID: 19062312 DOI: 10.1016/j.jse.2008.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 06/04/2008] [Accepted: 07/07/2008] [Indexed: 02/01/2023]
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30
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Chin KJ, Chan VW, van Geffen GJ. Ultrasound-guided infraclavicular block: the in-plane versus out-of-plane approach. Paediatr Anaesth 2008; 18:1279-80. [PMID: 19076611 DOI: 10.1111/j.1460-9592.2008.02814.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Perţea M, Luncă S, Moroşanu C. [Axillary wound with complete vasculo-nervous section. Functional outcomes]. REVISTA MEDICO-CHIRURGICALA A SOCIETATII DE MEDICI SI NATURALISTI DIN IASI 2008; 112:999-1002. [PMID: 20209776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Axillary wound with complete vasculonervous section are rare in adults, males between 20 and 30 years being more affected. In children these lesions are even more rarely encountered. Immediate surgical repair of vascular and nervous sections is recommended. Neurological impalement may be severe when all nervous trunks in the axilla are affected. Recovery of the motor and sensitive deficit is a long process and is often partial, good functional outcome being rare. Recovery in children is supposed to be better due to a more rapid regenerative capacity of the nerves. We present the case of a 9-year-old boy with axillary wound and complete section of axillary artery, median, ulnar, radial and musculocutaneous nerves and medial cutaneous nerve of arm. Vascular reconstruction with venous graft and epiperineural nerve reconstruction was done. Kinetotherapy and physiotherapy was part of recovery treatment. Follow up at 15 months confirmed very good functional outcomes with almost complete motor and sensitive function of the limb.
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32
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Torres Moreta MD, Rosado R, Gilsanz F. [Brachial fascial compartment hematoma after brachial plexus anesthesia with axillary nerve stimulation]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:52-53. [PMID: 18333390 DOI: 10.1016/s0034-9356(08)70501-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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33
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Fass G, Barchiche MR, Lemaitre J, De Quin I, Goffin C, Bricart R, Bellens B. Endovascular treatment of axillary artery dissection following anterior shoulder dislocation. Acta Chir Belg 2008; 108:119-121. [PMID: 18411587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Injury to the axillary artery is a rare complication of anterior shoulder dislocation. Open surgical repair is technically demanding because of the anatomical position of the vessel and the propensity for concomitant injuries. Standard surgical exposure techniques involve extensive dissection, including a combination of supraclavicular or infraclavicular incision, median sternotomy, and thoracotomy causing significant morbidity and mortality rates. Endovascular techniques may offer an alternative to these surgically demanding procedures. We present a patient with a traumatic dissection of the axillary artery following anterior shoulder dislocation who was successfully managed with an endovascular stent.
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Blackbourne LH, Mabry R, Sebesta J, Holcomb JB. Joseph Lister, noncompressible arterial hemorrhage, and the next generation of "tourniquets"? U.S. ARMY MEDICAL DEPARTMENT JOURNAL 2008:56-59. [PMID: 20091974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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35
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Tsuladze II, Dreval' ON. [Angular approach in the surgical treatment of the axillary neurovascular bundle pathologies]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2007:39-41. [PMID: 18274134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Different surgical approaches have been developed in the surgical treatment of various isolated and combined lesions of the axillary neurovascular bundle. The angular approach favorably differs from others and has a number of advantages. The angular approach was used to operate on 16 patients with varying abnormalities at this site, including 6 patients with traumatic lesion of the secondary trunks of the brachial plexus and 6 with space-occupying lesion, and 1 patient with the superior thoracic aperture; the remaining 6 patients with significant neurovascular compression syndrome, who had been operated on for various causes. The authors have made certain that the angular approach lightens a surgical intervention and shortens its duration substantially, by reducing the risk of postoperative pyoinflammatory complications, keloid cicatrices, and contractures. The surgical approach applied by the authors is universal and may be used in the treatment of pathology of the secondary trunks of the brachial plexus and vascular lesions, tumors, and pyoinflammatory processes of the axillary space.
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36
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Reeser JC. Diagnosis and management of vascular injuries in the shoulder girdle of the overhead athlete. Curr Sports Med Rep 2007; 6:322-7. [PMID: 17883968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Vascular injuries represent a rare cause of shoulder pain and functional limitation among overhead athletes. Complaints of heaviness, fatigue, paresthesias, and effort-related pain should prompt the sports medicine clinician to consider vascular pathology as a possible cause of such symptoms. Position-dependent compression of the subclavian and axillary vessels within the thoracic outlet may result in functional limitation and a decline in overhead athletic performance, particularly when symptoms occur in the dominant upper limb. Treatment options include physical therapy and (in the case of thrombus) thrombolysis, but surgical decompression of the neurovascular bundle is generally advocated. This article reviews the diagnosis and management of effort thrombosis (also known as Paget-Schroetter syndrome), arterial thoracic outlet syndrome, and entrapment of the posterior circumflex humeral artery within the quadrilateral space. Familiarity with these conditions may help to minimize the risk of delayed diagnosis and associated morbidity.
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37
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Oç M, Güvener M, Uçar HI, Akbulut B, Yilmaz M, Ersoy U. Isolated axillary artery injury due to blunt trauma. ULUS TRAVMA ACIL CER 2007; 13:145-8. [PMID: 17682958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The intimal damage of the axillary artery due to an acute, single blunt trauma is very rare without concomitant bone, brachial plexus, venous and soft tissue injuries. Early diagnosis and appropriate management of the arterial injury is essential to avoid permanent disability. The clinical signs are usually occult and do not become manifest until a long ischemic interval following injury, owing to the extensive collateral network. A twenty-year-old male patient had injured his left arm in a hyperabduction and hyperextension position while he was carrying a refrigerator with his arm. An increase in the intensity of pain and numbness reappeared in his left arm 1.5 months after the trauma. Digital subtraction angiography of the axillary artery performed after his hospitalization showed an occlusion of the axillary artery and no reconstitution of distal part of the occlusion via collateral vessels. During the operation, the axillary and brachial arteries were bypassed with a saphenous graft. As shown in this case report, in the early period after blunt trauma of the upper limb, progressive signs of vascular compromise may disappear because of collateral circulation even if the distal pulses are absent. Then an angiography of the upper limb becomes essential for correct diagnosis and treatment. This is our second experience. On the basis of our first experience that was reported, in such a chronic case, oral anticoagulation must be carried out at least six months whenever a graft thrombosis after revascularization is encountered.
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Lin CY, Chen SJ, Yu CT, Chang IL. Simultaneous bilateral anterior fracture dislocation of the shoulder with neurovascular injury: report of a case. Int Surg 2007; 92:89-92. [PMID: 17518250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
This paper reports an unusual case of orthopedic trauma in a 29-year-old man who experienced concomitant bilateral anterior shoulder fracture dislocation with associated brachial plexus and axillary artery injury. We also highlight the mechanism underlying this rare workplace injury related to use of a forklift.
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39
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Ersel M, Kiyan S, Aksay E, Eygi B, Calkavur T. Axillary artery dissection due to blunt shoulder trauma. Am J Emerg Med 2007; 25:242-3. [PMID: 17276837 DOI: 10.1016/j.ajem.2006.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Accepted: 11/02/2006] [Indexed: 11/17/2022] Open
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40
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Wera GD, Friess DM, Getty PO, Armstrong DG, Lacey SH, Baele HR. Fracture of the proximal humerus with injury to the axillary artery in a boy aged 13 years. ACTA ACUST UNITED AC 2006; 88:1521-3. [PMID: 17075102 DOI: 10.1302/0301-620x.88b11.18164] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fractures of the proximal humerus with concomitant vascular injury are rare in children. We describe the presentation, diagnosis, and treatment of a fracture of the proximal humerus in association with an axillary artery injury in a child.
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Schmal H, Strohm PC, Rosahl SK, Südkamp NP. [Rupture of the arteria subscapularis following reduction of an anterior shoulder dislocation]. Unfallchirurg 2006; 109:153-5. [PMID: 16059727 DOI: 10.1007/s00113-005-0983-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Anterior shoulder dislocations are one of the most common problems seen in an emergency department. Doubtless, immediate reduction is necessary for treatment, a procedure that is extremely rarely accompanied by complications. In these cases early diagnosis and treatment may be limb saving. We report a case with rupture of the arteria subscapularis following reduction of an anterior shoulder dislocation with formation of an axillary hematoma and consecutive paresis of the plexus brachialis. Interdisciplinary operative revision was necessary to remove the hematoma, stop the hemorrhage and for neurolysis of the plexus brachialis. Treatment resulted in a speedy recovery of the patient. Gentle reduction of a dislocated shoulder is a prerequisite for a low complication rate. Contrast-enhanced computed tomography facilitated diagnosis of the hematoma and identification of the bleeding vessel.
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Antevil JL, Holmes JF, Lewis D, Battistella F. Successful Angiographic Embolization of Bleeding into the Chest Wall after Blunt Thoracic Trauma. ACTA ACUST UNITED AC 2006; 60:1117-8. [PMID: 16688080 DOI: 10.1097/01.ta.0000196326.38754.da] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Veraldi GF, De Manzoni G, Tasselli S, Minicozzi A, Ruzzenente A, Pacca R, Firpo M. Iatrogenic axillary artery injury from humeral neck fracture repair. A rare and unusual event in which and aggressive strategy was mandatory to save a child limb. CHIRURGIA ITALIANA 2006; 58:247-51. [PMID: 16734175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Humeral neck fracture is rarely associated with injury of the nearby axillary artery and in the English literature only 29 such cases have been reported. An injury of the distal axillary artery secondary to reduction and fixation of a humeral neck fracture is a very rare and unusual complication, to the best of our knowledge has never been reported in literature. In this paper we report the case of entrapment of the distal axillary artery in the humerus rhyme fracture in a 9-year-old child who suffered a nighttime car-accident with her father. At admission, the child presented a left humeral neck fracture with no other lesions and no neurologic problems in her limb; peripheral pulses present in her left hand at palpation. After closed reduction and pinning of the fracture with 2 K-wires, the left upper limb became ischemic and pulseless and the child was transferred at our Institution for diagnosis and treatment. In this paper we discuss the treatment to be adopted in this very unusual situation.
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44
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Battiston B, Bertoldo U, Tos P, Cimino F. Primary nerve repair in associated lesions of the axillary artery and brachial plexus. Microsurgery 2006; 26:311-5. [PMID: 16628743 DOI: 10.1002/micr.20244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Diagnosis becomes more complex when there is an association of a brachial plexus injury with an arterial lesion. The principal clinical picture in most cases is acute ischemia that requires initial treatment in the emergency room, and the final results of nerve repair are generally poorer. Although delayed brachial plexus reconstruction is preferred by some authors, our experience leads us to the opinion that a combined repair presents several advantages. Immediately after trauma, the surgical field is free of scar tissue, and a precise evaluation of both the number and level of damaged nerves may be made. Vascular and nerve repair may be mutually agreed upon by both the vascular surgeon and microsurgeon, and simple sutures may often be used instead of grafts in early nerve repair. Even if the extent of nerve damage may sometimes be difficult to assess, the results of early, easier repairs can be observed in our series of 14 combined lesions. Our results indicate that collaboration between microsurgeons and vascular surgeons is a very important factor in providing a correct approach to these problematic patients.
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45
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Aksoy M, Tunca F, Yanar H, Guloglu R, Ertekin C, Kurtoglu M. Traumatic injuries to the subclavian and axillary arteries: a 13-year review. Surg Today 2005; 35:561-5. [PMID: 15976953 DOI: 10.1007/s00595-005-2990-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Accepted: 11/16/2004] [Indexed: 12/20/2022]
Abstract
PURPOSE By reviewing our experience, we evaluated the presentation, management, and long-term outcome of patients with subclavian and axillary artery injuries resulting from trauma. METHODS We retrospectively reviewed the data of 38 patients who received treatment for subclavian or axillary artery injuries in the Emergency and Trauma Department of Medical Faculty of Istanbul, Istanbul University between January 1989 and July 2002. RESULTS Arterial injuries were repaired with an end-to-end anastomosis in 10 (26.3%) patients, primary repair in 6 (15.7%), autologous vein graft interposition in 16 (42%), ligation in 5 (13.1%), and a proximal subclavian-brachial artery bypass in 1 (2.6%). One (2.6%) of the arterial reconstructions failed in the perioperative period. Fourteen (36%) patients presented with a neurological deficit, which recovered after the intervention in 2 (5.2%) patients. A wound infection developed in 8 (21%) patients and 2 (5.2%) patients died of concomitant injuries. Thirteen (36.1%) of the remaining 36 patients were followed up for a mean period of 7 months. CONCLUSION Successful management of subclavian and axillary artery injuries requires prompt diagnosis because the occult nature of these injuries necessitates a high index of suspicion. Although revascularization procedures are often successful, it is the associated neurological, orthopedic, and soft tissue injuries that affect the functional outcome of the limb.
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46
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Stahnke M, Duddy MJ. Endovascular Repair of a Traumatic Axillary Pseudoaneurysm Following Anterior Shoulder Dislocation. Cardiovasc Intervent Radiol 2005; 29:298-301. [PMID: 16283573 DOI: 10.1007/s00270-005-0071-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pseudoaneurysms due to musculoskeletal trauma are rare and comprise less than 2% of all pseudoaneurysms. We report a case of axillary pseudoaneurysm following anterior dislocation of the shoulder. The patient was successfully treated by endovascular intervention.
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Abstract
Dislocation of the shoulder joint is common. The shoulder is affected in up to 60% of all major joint dislocations, one study citing an incidence of 1.7% in the general population. The most common form is anteroinferior dislocation. A variety of techniques to reduce shoulder dislocation has been described. The key to successful relocation is a thorough understanding of the anatomy of both the enlocated and the dislocated shoulder joint.
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48
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Pecinska N, Nussbaumer P, Furrer M. [Acute vascular occlusion of the upper extremity after blunt trauma]. VASA 2005; 34:201-2. [PMID: 16184842 DOI: 10.1024/0301-1526.34.3.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intimal ruptures after blunt trauma without joint dislocation are rare. We report the case of a 62 year old male patient presenting with paraesthesia in the fingers I to III and a cool left hand after a blunt trauma of the upper arm. Non-invasive examination documented the thrombotic occlusion of the axillary artery. Due to a circular rupture of the intima surgical revascularization was performed with a vein graft.
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49
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Chung HH, Cha SH, Cho SB, Kim JH, Lee SH, Shin JS, Park SW. Traumatic Axillary Artery Dissection with Radial Artery Embolism. Cardiovasc Intervent Radiol 2005; 29:294-7. [PMID: 16160753 DOI: 10.1007/s00270-004-8103-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This report describes a case of pathologically proven traumatic arterial dissection, presenting as complete occlusion of the axillary artery with radial artery embolism. Occlusion of the axillary artery by traumatic dissection mimicked transection and radial artery embolism mimicked congenital absence of the radial artery on the initial angiogram, but these were correctly diagnosed with the following sonogram.
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50
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Allie B, Kilroy DA, Riding G, Summers C. Rupture of axillary artery and neuropraxis as complications of recurrent traumatic shoulder dislocation: case report. Eur J Emerg Med 2005; 12:121-3. [PMID: 15891444 DOI: 10.1097/00063110-200506000-00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gleno-humeral dislocations are frequent, but associated complete transection of the axillary artery has only been reported sporadically. We present a case of complete rupture of the axillary artery associated with recurrent anterior dislocation of the shoulder, followed by a discussion of the likely mechanisms and the key learning points.
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