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Aerts NR, Poli de Figueiredo LF, Burihan E. Emergency room retrograde transbrachial arteriography for the management of axillosubclavian vascular injuries. THE JOURNAL OF TRAUMA 2003; 55:69-73. [PMID: 12855883 DOI: 10.1097/01.ta.0000073135.07925.b7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Our purpose was to determine the accuracy of single-injection, retrograde transbrachial arteriography (RTBA), performed in the emergency room, for suspected axillosubclavian injuries. METHODS Thirty-three patients were prospectively assigned for RTBA. Clinical indications for RTBA included high-risk mechanism of injury, decreased (n = 19) or absent (n = 5) brachial pulse, neurologic deficits (n = 11), external or intrathoracic bleeding (n = 4), and bruit (n = 2). Brachial artery was cannulated with an 18-gauge catheter. A sphygmomanometer cuff was placed at the forearm and inflated to 250 mm Hg. Twenty milliliters of nonionic contrast media was injected countercurrent and a single anteroposterior chest radiograph was obtained. Small intimal flaps were followed by serial ultrasound. Surgical findings were used to establish RTBA accuracy. RESULTS RTBA was successfully performed in all cases. Arterial lesions were detected in 28 (84.8%) patients, including thrombosis (n = 8), arteriovenous fistula (n = 8), and false aneurysm (n = 7) as the most frequent lesions. A sensitivity of 96.5%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 80% were observed with RTBA. CONCLUSION We conclude that RTBA is a safe and accurate technique to be used in the emergency room for the rapid detection of axillosubclavian arterial injuries.
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Unlü Y, Tekin SB, Ceviz M, Balci A. A successful right axillary artery graft to repair a ruptured axillary artery due to the involvement of lymphoma: report of a case. Surg Today 2003; 33:72-4. [PMID: 12560914 DOI: 10.1007/s005950300015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Diffuse large B-cell lymphoma is a very common, highly invasive lymphoma, which typically presents as a rapidly enlarging symptomatic mass with local compression of vessels or airways, and often is involved with the peripheral nerves and the destruction of bone. Vascular invasion is extremely rare. We herein describe the case of a successfully treated 42-year-old man who presented with massive bleeding due to a rupture of the axillary artery and vein involvement due to lymphoma.
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78
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Murthy R, Arbabzadeh M, Richard H, Levitin A, Lund G, Stainken B, Cooper C. Axillary artery traumatic pseudoaneurysm managed with a Wallgraft Endoprothesis. J Vasc Interv Radiol 2003; 14:117-8. [PMID: 12525598 DOI: 10.1016/s1051-0443(07)60100-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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79
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80
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Razif MAM, Rajasingam V. Anterior shoulder dislocation with axillary artery and nerve injury. THE MEDICAL JOURNAL OF MALAYSIA 2002; 57:496-8. [PMID: 12733178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
We report a rare case of left axillary artery injury associated with anterior dislocation of the left shoulder in a 25 yrs old male as a result of a road traffic accident. The shoulder dislocation was reduced. A left upper limb angiogram showed an obstructed left axillary artery. The obstructed segment was surgically reconstructed with a Dacron graft. Six months post operation in follow up, he was found to have good left shoulder function and no neurovascular deficit. This is an injury that could have been easily missed without a simple clinical examination.
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81
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Watanabe-Suzuki K, Suzuki O, Nozawa H, Ishii A. An autopsy case of a stunt man who jumped into seawater riding a motorcycle: a case report. MEDICINE, SCIENCE, AND THE LAW 2002; 42:355-357. [PMID: 12487523 DOI: 10.1177/002580240204200413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We report a rare case of the death of a stunt man who jumped into the sea driving a motorcycle on location for a TV drama. A special ramp had been constructed for the jump. The stunt man and a passenger drove up the ramp at a speed of 60-70 km/h and jumped into the sea from a height of about five metres. Both men swam up, but the driver fell unconscious at the surface. He was sent to hospital, but did not recover. The autopsy revealed a deep laceration of the right axilla with complete rupture of the axillary artery, bone fractures of the right ribs and the right pelvis, and a small laceration of the upper lobe of the right lung. Other visceral organs were not injured. We finally judged that his cause of death was exsanguination due to rupture of the right axillary artery on the basis of the presence of a small amount of blood inside the heart and ischemic organs. All injuries were probably inflicted by a collision with the motorcycle upon reaching the water surface; the axillary injury might be due to the left handlebar piercing into the part.
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82
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Maweja S, Sakalihasan N, Van Damme H, Limet R. Axillary artery injury secondary to anterior shoulder dislocation: report of two cases. Acta Chir Belg 2002; 102:187-91. [PMID: 12136538 DOI: 10.1080/00015458.2002.11679291] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Vascular injuries secondary to isolated shoulder dislocation are rare. Unawareness for closed axillary artery trauma by many physicians treating shoulder dislocations, counts often for missed or delayed diagnosis. The authors describe two cases that presented with an anterior shoulder dislocation, complicated by a disruption of the axillary artery with subsequent thrombosis. The various pathogenic mechanisms are discussed. The pathognomic triad consists of anterior shoulder dislocation, absent or diminished distal pulse and an axillary protruding hematoma. Prompt surgical arterial repair is mandatory.
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83
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Helm AT, Watson JS. Compression of the brachial plexus in a patient with false aneurysm of the axillary artery as a result of anterior shoulder dislocation. J Shoulder Elbow Surg 2002; 11:278-9. [PMID: 12070503 DOI: 10.1067/mse.2002.122231] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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84
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Wali MA. Axillary artery injury: report of two cases and review of the literature. AFRICAN JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2002; 31:87-9. [PMID: 12518939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
These are the cases of two young men, 21- and 28-year old, who sustained penetrating stab injuries to their axillary arteries. Both patients presented initially with profuse bleeding and were in a state of shock. The first patient underwent initial emergency surgery to control his bleeding whereby deep stitches were inserted around the axillary vessels and nerves and ended up with permanent iatrogenic Median nerve palsy. The bleeding in the second patient was controlled initially by compression dressing and he underwent successful vascular repair of the axillary artery with full recovery of his upper limb function. In this paper, we are discussing the initial management problem of these cases and the results of similar injuries and their repair in the literature.
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85
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Dinkel HP, Eckstein FS, Triller J, Do DD. Emergent axillary artery stent-graft placement for massive hemorrhage from an avulsed subscapular artery. J Endovasc Ther 2002; 9:129-33. [PMID: 11958317 DOI: 10.1177/152660280200900121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the successful endovascular repair of an acute axillary artery hemorrhage. CASE REPORT An 87-year-old woman with Charcot-Marie-Tooth ataxia presented with an enormous shoulder hematoma and clinical signs of exsanguination after a fall. Angiography demonstrated complete avulsion of the right subscapular artery from the axillary artery, and active bleeding into a hematoma of at least 1500 mL. Endovascular repair with a balloon-mounted covered stent-graft was performed percutaneously, which controlled the bleeding and averted surgery. The patient recovered uneventfully and was without signs of recurrent bleeding or ischemia on the 6-month ultrasound examination; she reports no symptoms referable to her upper extremity after 14 months. CONCLUSIONS Endovascular repair with stent-grafts is effective in controlling arterial bleeding from supra-aortic vessels even under emergency conditions.
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86
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Chevalier J, Joly P, Dhoine P. [Aneurysm and axillary crutches]. JOURNAL DES MALADIES VASCULAIRES 2002; 27:36-8. [PMID: 12070840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Axillary crutches may injure the axillary artery. A 65-year-old woman with a leg length discrepancy of 30 cm subsequent to childhood poliomyelitis was seen for subacute ischemia of the right upper limb. Axillary aneurysm with thrombosis due to chronic use of axillary crutches was diagnosed after clinical examinations and surgery. Resection-graft of the aneurysm and thrombectomy was performed and restored patency. Axillary crutches may cause arterial stenosis or aneurysms. Aneurysms may be complicated by acute thrombosis, chronic or acute distal embolization, or axillary mass formation. Besides not using axillary crutches, surgical treatment of crutch-induced axillary aneurysm must be performed before sometimes definitive sequelae develop.
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87
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Zanchetta M, Rigatelli G, Dimopoulos K, Pedon L, Zennaro M, Maiolino P. Endoluminal repair of axillary artery and vein rupture after reduction of shoulder dislocation. A case report. Minerva Cardioangiol 2002; 50:69-73. [PMID: 11830721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A case of endoluminal repair of vein and artery axillary rupture after reduction of shoulder dislocation in an 83-year-old woman is reported. The lesions were repaired successfully with two cover stents (JOSTENT and Passager). Endovascular treatment of such vascular injuries seems to be feasible and safe, though further investigation is warranted.
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Abstract
Injuries to the subclavian or axillary vessels are associated with a high mortality rate and only patients with short prehospital periods or contained bleeding survive long enough to be treated. The surgical exposure of these vessels can be difficult and excellent knowledge of the local anatomy is critical. This article describes the anatomy, epidemiology, diagnosis, and surgical exposure of these injuries. Newer diagnostic and therapeutic modalities are discussed also.
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89
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Patel J, Turner M, Birch R, McCrory P. Rupture of the axillary (circumflex) nerve and artery in a champion jockey. Br J Sports Med 2001; 35:361-2; discussion 363. [PMID: 11579075 PMCID: PMC1724382 DOI: 10.1136/bjsm.35.5.361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Rupture of the circumflex artery and nerve, without fracture or dislocation, is a rare traumatic event. Such a case is reported in a champion flat jockey who sustained blunt trauma to the shoulder after a fall during a race; the literature is also reviewed. At urgent surgical exploration, the axillary artery and nerve were repaired. The patient subsequently successfully returned to professional riding. This case highlights the difficulties in diagnosis and management.
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90
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Hodina M, Gudinchet F, Reinberg O, Schnyder P. Imaging of blunt arterial trauma of the upper extremity in children. Pediatr Radiol 2001; 31:564-8. [PMID: 11550768 DOI: 10.1007/s002470100509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report four patients with blunt arterial trauma of the upper limb following unusual mechanisms of injury in two patients (one fell on the handlebars of his bicycle, the second was crushed by a moving lawn mower) and due to bicycle accidents in two further patients. The use of digital subtraction angiography (DSA) in all patients, together with colour Doppler imaging (CDI) in one patient, provided optimum preoperative identification and localisation of the arterial lesions.
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91
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Shergill G, Bonney G, Munshi P, Birch R. The radial and posterior interosseous nerves. Results fo 260 repairs. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 2001; 83:646-9. [PMID: 11476297 DOI: 10.1302/0301-620x.83b5.11312] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The outcome of 260 repairs of the radial and posterior interosseous nerves, graded by Seddon's modification of the Medical Research Council Special Committee's system, was analysed according to four patterns of injury; open 'tidy', open 'untidy', closed traction, and those associated with injury to the axillary or brachial artery. We studied the effect on the outcome of delay in effecting repair and of the length of the defect in the nerve trunk. Of the 242 repairs of the radial nerve we found that 30% had good results and 28% fair; 42% of the repairs had failed. The violence of injury was the most important factor in determining the outcome. Of the open 'tidy' repairs, 79% achieved a good or fair result, and 36% of cases with arterial injury also reached this level. Most repairs failed when the defect in the nerve trunk exceeded 10 cm. When the repairs were carried out within 14 days of injury, 49% achieved a good result; only 28% of later repairs did so. All repairs undertaken after 12 months failed. Of the 18 repairs of the posterior interosseous nerve, 16 achieved a good result.
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92
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Satiani B. Regarding "Subclavian arterial injury associated with blunt trauma" (Vascular Surgery 35:43-50, 2001). VASCULAR SURGERY 2001; 35:333. [PMID: 11586462 DOI: 10.1177/153857440103500416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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93
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Witz M, Korzets Z, Lehmann J. Traumatic scapulothoracic dissociation. THE JOURNAL OF CARDIOVASCULAR SURGERY 2000; 41:927-9. [PMID: 11232978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Scapulothoracic dissociation is an infrequent injury with a potentially devastating outcome. The diagnosis is based on clinical and radiographic findings of forequarter disruption. These include massive soft tissue swelling of the shoulder, displacement of the scapula and neurovascular injuries (brachial plexus, subclavian artery and osseous-ligamentous injuries). The mechanism of injury appears to be the delivery of severe rotational force sheering the shoulder girdle from its chest wall attachments around the scapula, shoulder joint and at the clavicle. Early recognition of the entity and aggressive treatment are crucial. Outcome is not dependent on management of the arterial injury, but rather on the severity of the neurological deficit.
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Tiesenhausen K, Amann W, Koch G, Kern M, Scholz R. [Arterial complications caused by using an axillary crutch]. ZEITSCHRIFT FUR ORTHOPADIE UND IHRE GRENZGEBIETE 2000; 138:544-6. [PMID: 11199422 DOI: 10.1055/s-2000-9599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Of all upper extremity emboli, up to twenty percent arise from an arterial, not a cardiac source. METHOD We report about a patient with recurrent embolism, caused by an axillary crutch-induced aneurysm of the axillary artery. RESULT After revascularisation by embolectomy and axillo-brachial vein graft bypass, the patient was free of symptoms. CONCLUSION Angiography and duplex scanning were necessary for the correct diagnosis.
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MacNamara AF, Ismail A. Combined brachial plexus and vascular injury in the absence of bony injury. J Accid Emerg Med 2000; 17:378-9. [PMID: 11005418 PMCID: PMC1725456 DOI: 10.1136/emj.17.5.378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Neurovascular injury to the axillary vessels is well described in association with fracture or dislocation involving the shoulder joint or the humerus. Such injury however can also occur in the absence of bony injury. A case is presented of damage to the axillary artery and brachial plexus following blunt trauma. This case demonstrates that complex neurovascular damage can occur in the absence of fracture or dislocation. The importance of a thorough clinical assessment is highlighted and priorities with regard to diagnosis and management are discussed.
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Velinovic MM, Davidovic BL, Lotina IS, Vranes RM, Djukic LP, Arsov JV, Ristic VM, Kocica JM, Petrovic LP. Complications of operative treatment of injuries of peripheral arteries. CARDIOVASCULAR SURGERY (LONDON, ENGLAND) 2000; 8:256-64. [PMID: 10840202 DOI: 10.1016/s0967-2109(00)00020-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In 1991 and 1992, a total of 97 patients with 106 peripherial arterial injuries underwent surgery at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia. Civilian injuries accounted for 53 (54.6%) patients (94.3% males, age range: 16-63 yr, mean: 35.2), and 44 patients had war injuries (93.2% males, age range: 19-61 yr, mean: 34.8). The injuries affected the superfitial femoral artery in 31 (29.24%); the popliteal artery in 28 (26.41%); the brachial artery in 17 (16.04%); the posterior tibial artery in 6 (5.66%); the axillary artery in 5 (4.72%); the anterior tibial artery in 5 (4.72%); the tibioperoneal trunk in 4 (3. 77%); the common femoral artery in 4 (3.77%); the external iliac artery in 2 (1.89%); the profound femoral artery in 2 (1.89%); the radial artery in 1 (0.94%); and ulnar artery in 1 (0.94%).A total of 98 reconstructive procedures were used to treat these patients. Graft interposition carried out in 50 (51.02%); by pass in 25 (25. 51%); end-to-end anastomosis in 9 (9.18%); suture in 8 (8.16%); ligation in 4 (4.08%); and patch-angioplasty in 2 (2.04%). Primary reconstruction of injured arteries was performed in 72.2% and secondary repair in 27.8% cases. Infection developed in 51 (52.57%) patients, and it was significantly (P<0.05) more common in the war injuries (70.45%) and in secondary repairs (88.89%). The presence of associated lesions (69.56%) was also correlated with a greater rate of infection. Amputation was necessary in 21 (21.65%) of our patients, and was significantly (P<0.05) more often performed after secondary (44.44%) than primary operations (12.86%) and in the presence of associated injuries (32.61%).
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Guvener M, Kaplan S, Demircin M, Pasaoglu I. Axillary artery injury: an isolated, delayed case after blunt trauma of the upper limb. THE JOURNAL OF TRAUMA 2000; 48:951-3. [PMID: 10823543 DOI: 10.1097/00005373-200005000-00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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98
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du Toit DF, Strauss DC, Blaszczyk M, de Villiers R, Warren BL. Endovascular treatment of penetrating thoracic outlet arterial injuries. Eur J Vasc Endovasc Surg 2000; 19:489-95. [PMID: 10828229 DOI: 10.1053/ejvs.1999.1050] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to establish the feasibility of stent-graft treatment of penetrating thoracic outlet arterial injuries. DESIGN prospective study. MATERIALS AND METHODS forty-one patients with penetrating injuries to the carotid, subclavian and proximal axillary arteries admitted between August 1998 and May 1999 were studied. Patients requiring urgent surgical exploration for active bleeding (n=26) were excluded. Remaining patients underwent arteriography to assess suitability for stent-graft placement. After successful stent-graft treatment clinical and sonographic follow-up were done at 1 month and thereafter 3-monthly. RESULTS of the 15 patients considered, 10 patients qualified for stent-graft treatment (seven male, three female, mean age 27 years). The vessels involved were subclavian artery (seven), carotid artery (two) and axillary artery (one). Seven had arteriovenous fistulae and three, pseudoaneurysms. Stent-graft treatment was successful in all 10 patients with no procedure-related complications. On mean follow-up of 7 months no complications were encountered. CONCLUSION endovascular treatment shows promise as a treatment modality for thoracic outlet arterial injuries. Long-term follow-up is required for comparison to the results of standard surgical repair.
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Caiati JM, Masters CM, Todd EJ, Benvenisty AI, Todd GJ. Symptomatic axillary artery dissection in a tennis player. Case report. Am J Sports Med 2000; 28:411-2. [PMID: 10843138 DOI: 10.1177/03635465000280032301] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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100
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Sparks SR, DeLaRosa J, Bergan JJ, Hoyt DB, Owens EL. Arterial injury in uncomplicated upper extremity dislocations. Ann Vasc Surg 2000; 14:110-3. [PMID: 10742423 DOI: 10.1007/s100169910020] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The purpose of this study is to analyze causes and consequences of arterial injury complicating simple dislocations of the upper extremity. This is a multicenter, 5-year, retrospective analysis of vascular injury in patients sustaining shoulder or elbow dislocations without associated fractures. Foci of the study were mechanisms of injury, preoperative imaging, incidence of closed reductions, types of arterial injury, methods of surgical repair, and ultimate outcome. Arterial injury in this patient cohort occurred in 0.74% of patients. Axillary artery injury occurred in 0. 97% and brachial in 0.47%. Both elbow and shoulder dislocations may cause severe arterial damage and strenuously test surgical expertise to achieve successful repair.
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