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Forsyth A, Haqqani MH, Alfson DB, Shaikh SP, Brea F, Richman A, Siracuse JJ, Rybin D, Farber A, Brahmbhatt TS. Long-term outcomes of autologous vein bypass for repair of upper and lower extremity major arterial trauma. J Vasc Surg 2024; 79:1339-1346. [PMID: 38301809 DOI: 10.1016/j.jvs.2024.01.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Autologous vein is the preferred bypass conduit for extremity arterial injuries owing to superior patency and low infection risk; however, long-term data on outcomes in civilians are limited. Our goal was to assess short- and long-term outcomes of autologous vein bypass for upper and lower extremity arterial trauma. METHODS A retrospective review was performed of patients with major extremity arterial injuries (2001-2019) at a level I trauma center. Demographics, injury and intervention details, and outcomes were recorded. Primary outcomes were primary patency at 1 year and 3 years. Secondary outcomes were limb function at 6 months, major amputation, and mortality. Multivariable analysis determined risk factors for functional impairment. RESULTS There were 107 extremity arterial injuries (31.8% upper and 68.2% lower) treated with autologous vein bypass. Mechanism was penetrating in 77% of cases, of which 79.3% were due to firearms. The most frequently injured vessels were the common and superficial femoral (38%), popliteal (30%), and brachial arteries (29%). For upper extremity trauma, concomitant nerve and orthopedic injuries were found in 15 (44.1%) and 11 (32.4%) cases, respectively. For lower extremities, concomitant nerve injuries were found in 10 (13.7%) cases, and orthopedic injuries in 31 (42.5%). Great saphenous vein was the conduit in 96% of cases. Immediate intraoperative bypass revision occurred in 9.3% of patients, most commonly for graft thrombosis. The in-hospital return to operating room rate was 15.9%, with graft thrombosis (47.1%) and wound infections (23.5%) being the most common reasons. The median follow-up was 3.6 years. Kaplan-Meier analysis showed 92% primary patency at 1 year and 90% at 3 years. At 6 months, 36.1% of patients had functional impairment. Of patients with functional impairment at 6 months, 62.9% had concomitant nerve and 60% concomitant orthopedic injuries. Of those with nerve injury, 91.7% had functional impairment, compared with 17.8% without nerve injury (P < .001). Of patients with orthopedic injuries, 51.2% had functional impairment, vs 25% of those without orthopedic injuries (P = .01). On multivariable analysis, concomitant nerve injury (odds ratio, 127.4; 95% confidence interval, 17-957; P <. 001) and immediate intraoperative revision (odds ratio, 11.03; 95% confidence interval, 1.27-95.55; P = .029) were associated with functional impairment. CONCLUSIONS Autologous vein bypass for major extremity arterial trauma is durable; however, many patients have long-term limb dysfunction associated with concomitant nerve injury and immediate intraoperative bypass revision. These factors may allow clinicians to identify patients at higher risk for functional impairment, to outline patient expectations and direct rehabilitation efforts toward improving functional outcomes.
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Affiliation(s)
- Alexandra Forsyth
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Maha H Haqqani
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA.
| | - Daniel B Alfson
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Shams P Shaikh
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Fernando Brea
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Aaron Richman
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Denis Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Tejal S Brahmbhatt
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
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Yahn C, Haqqani MH, Alonso A, Kobzeva-Herzog A, Cheng TW, King EG, Farber A, Siracuse JJ. Long-term functional outcomes of upper extremity civilian vascular trauma. J Vasc Surg 2024; 79:526-531. [PMID: 37992948 DOI: 10.1016/j.jvs.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE Civilian analyses of long-term outcomes of upper extremity vascular trauma (UEVT) are limited. Our goal was to evaluate the management of UEVT in the civilian trauma population and explore the long-term functional consequences. METHODS A retrospective review and analysis was performed of patients with UEVT at an urban Level 1 trauma center (2001-2022). Management and long-term functional outcomes were analyzed. RESULTS There were 150 patients with UEVT. Mean age was 34 years, and 85% were male. There were 42% Black and 27% White patients. Mechanism was penetrating in 79%, blunt in 20%, and multifactorial in 1%. Within penetrating trauma, mechanism was from firearms in 30% of cases. Of blunt injuries, 27% were secondary to falls, 13% motorcycle collisions, 13% motor vehicle collisions, and 3% crush injuries. Injuries were isolated arterial in 62%, isolated venous in 13%, and combined in 25% of cases. Isolated arterial injuries included brachial (34%), radial (27%), ulnar (27%), axillary (8%), and subclavian (4%). The majority of arterial injuries (92%) underwent open repair with autologous vein bypass (34%), followed by primary repair (32%), vein patch (6.6%), and prosthetic graft (3.3%). There were 23% that underwent fasciotomies, 68% of which were prophylactic. Two patients were managed with endovascular interventions; one underwent covered stent placement and the other embolization. Perioperative reintervention occurred in 12% of patients. Concomitant injuries included nerves (35%), bones (17%), and ligaments (16%). Intensive care unit admission was required in 45%, with mean intensive care unit length of stay 1.6 days. Mean hospital length of stay was 6.7 days. Major amputation and in-hospital mortality rates were 1.3% and 4.6% respectively. The majority (72%) had >6-month follow-up, with a median follow-up period of 197 days. Trauma readmissions occurred in 19%. Many patients experienced chronic pain (56%), as well as motor (54%) and sensory (61%) deficits. Additionally, 41% had difficulty with activities of daily living. Of previously employed patients (57%), 39% experienced a >6-month delay in returning to work. Most patients (82%) were discharged with opioids; of these, 16% were using opioids at 6 months. CONCLUSIONS UEVT is associated with long-term functional impairments and opioid use. It is imperative to counsel patients prior to discharge and ensure appropriate follow-up and therapy.
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Affiliation(s)
- Colten Yahn
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston
| | - Maha H Haqqani
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston
| | - Andrea Alonso
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston
| | - Anna Kobzeva-Herzog
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston
| | - Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston
| | - Elizabeth G King
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston.
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Haney LJ, Bae E, Pugh MJV, Copeland LA, Wang CP, MacCarthy DJ, Amuan ME, Shireman PK. Patency of arterial repairs from wartime extremity vascular injuries. Trauma Surg Acute Care Open 2020; 5:e000616. [PMID: 33409373 PMCID: PMC7768973 DOI: 10.1136/tsaco-2020-000616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Extremity vascular injury (EVI) causes significant disability in Veterans of the Afghanistan/Iraq conflicts. Advancements in acute trauma care improved survival and decreased amputations. The study of wartime EVI has relied on successful limb salvage as a surrogate for vascular repair. We used imaging studies as a specific measure of arterial repair durability. METHODS Service members with EVI were identified using the Department of Defense Trauma Registry and validated by chart abstraction. Inclusion criteria for the arterial patency subgroup included an initial repair attempt with subsequent imaging reports (duplex ultrasound, CT angiography, and angiogram) documenting initial patency. RESULTS The cohort of 527 included 140 Veterans with available imaging studies for 143 arterial repairs; median follow-up from injury time to last available imaging study was 19 months (Q1-Q3: 3-58; range: 1-175). Injury mechanism was predominantly explosions (52%) and gunshot wounds (42%). Of the 143 arterial repairs, 81% were vein grafts. Eight repairs were occluded, replaced or included in extremity amputations. One upper extremity and three transtibial late amputations were performed for chronic pain and poor function averaging 27 months (SD: 4; range: 24-32). Kaplan-Meier analysis estimated patency rates of 99%, 97%, 95%, 91% and 91% at 3, 6, 12, 24, and 36 months, respectively, with similar results for upper and lower extremity repairs. Explosive and gunshot wound injury mechanisms had similar patency rates and upper extremity injuries repaired with vein grafts had increased patency. CONCLUSIONS Arterial repair mid-term patency in combat-related extremity injuries is excellent based on imaging studies for 143 repairs. Assertive attempts at acute limb salvage and vascular repair are justified with decisions for amputation versus limb salvage based on the overall condition of the patient and degree of concomitant nerve, orthopedic and soft tissue injuries rather than the presence of arterial injuries. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
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Affiliation(s)
- Lauren J Haney
- Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA,South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Esther Bae
- South Texas Veterans Health Care System, San Antonio, Texas, USA,Surgery, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Mary Jo V Pugh
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA,Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA,Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chen-Pin Wang
- South Texas Veterans Health Care System, San Antonio, Texas, USA,Population Health Sciences, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Daniel J MacCarthy
- South Texas Veterans Health Care System, San Antonio, Texas, USA,Population Health Sciences, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Megan E Amuan
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Paula K Shireman
- Surgery, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA,Surgery, South Texas Veterans Health Care System, San Antonio, Texas, USA
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Shakeri-Bavil A, Zarrintan S. Angiographic evaluation of traumatic arterial injuries of the upper limbs: a retrospective study. J Cardiovasc Thorac Res 2020; 12:69-72. [PMID: 32211141 PMCID: PMC7080338 DOI: 10.34172/jcvtr.2020.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/19/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction: The aim of this study was to evaluate the mechanism and type of upper limb arterial trauma in Iranian population. Methods: Fifty-one patients with upper limb trauma were evaluated over a 4-year period with conventional angiography at the Tabriz Imam Hospital, Iran. Results: Twenty-four patients (19 men, 5 women with a mean age of 27.5 ± 11.8 years) had arterial injuries. Blunt trauma was more frequent than penetrating trauma (87.5%). The most cause of trauma was traffic accidents and the brachial artery was the most frequently affected artery. In 87.5% cases associated bone injuries were observed. Conclusion: Patients with blunt upper limb injuries must be evaluated for vascular integrity timely, especially in traffic accidents because vascular injuries after traffic accidents need to be referred to vascular centers. The results of this article are of potential use and clinical importance because precise diagnosis of vascular insults are essential to restore injured extremities.
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Affiliation(s)
| | - Sina Zarrintan
- Department of General & Vascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Thai JN, Pacheco JA, Margolis DS, Swartz T, Massey BZ, Guisto JA, Smith JL, Sheppard JE. Evidence-based Comprehensive Approach to Forearm Arterial Laceration. West J Emerg Med 2015; 16:1127-34. [PMID: 26759666 PMCID: PMC4703190 DOI: 10.5811/westjem.2015.10.28327] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/24/2015] [Accepted: 10/30/2015] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Penetrating injury to the forearm may cause an isolated radial or ulnar artery injury, or a complex injury involving other structures including veins, tendons and nerves. The management of forearm laceration with arterial injury involves both operative and nonoperative strategies. An evolution in management has emerged especially at urban trauma centers, where the multidisciplinary resource of trauma and hand subspecialties may invoke controversy pertaining to the optimal management of such injuries. The objective of this review was to provide an evidence-based, systematic, operative and nonoperative approach to the management of isolated and complex forearm lacerations. A comprehensive search of MedLine, Cochrane Library, Embase and the National Guideline Clearinghouse did not yield evidence-based management guidelines for forearm arterial laceration injury. No professional or societal consensus guidelines or best practice guidelines exist to our knowledge. DISCUSSION The optimal methods for achieving hemostasis are by a combination approach utilizing direct digital pressure, temporary tourniquet pressure, compressive dressings followed by wound closure. While surgical hemostasis may provide an expedited route for control of hemorrhage, this aggressive approach is often not needed (with a few exceptions) to achieve hemostasis for most forearm lacerations. Conservative methods mentioned above will attain the same result. Further, routine emergent or urgent operative exploration of forearm laceration injuries are not warranted and not cost-beneficial. It has been widely accepted with ample evidence in the literature that neither injury to forearm artery, nerve or tendon requires immediate surgical repair. Attention should be directed instead to control of bleeding, and perform a complete physical examination of the hand to document the presence or absence of other associated injuries. Critical ischemia will require expeditious surgical restoration of arterial perfusion. In a well-perfused hand, however, the presence of one intact artery is adequate to sustain viability without long-term functional disability, provided the palmar arch circulation is intact. Early consultation with a hand specialist should be pursued, and follow-up arrangement made for delayed primary repair in cases of complex injury. CONCLUSION Management in accordance with well-established clinical principles will maximize treatment efficacy and functional outcome while minimizing the cost of medical care.
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Affiliation(s)
- Janice N Thai
- University of Arizona Medical Center, Department of Surgery, Division of Vascular Surgery, Tucson, Arizona
| | - Jose A Pacheco
- National Autonomous University of Honduras School of Medicine, Tegucigalpa, Honduras
| | - David S Margolis
- University of Arizona Medical Center, Department of Orthopaedic Surgery, Tucson, Arizona
| | - Tianyi Swartz
- University of Arizona Medical Center, Department of Surgery, Tucson, Arizona
| | | | - John A Guisto
- University of Arizona Medical Center, Department of Emergency Medicine, Tucson, Arizona
| | - Jordan L Smith
- University of Arizona Medical Center, Department of Orthopaedic Surgery, Tucson, Arizona
| | - Joseph E Sheppard
- University of Arizona Medical Center, Department of Orthopaedic Surgery, Tucson, Arizona
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Lannau B, Bliley J, James IB, Wang S, Sivak W, Kim K, Fowler J, Spiess AM. Long-term Patency of Primary Arterial Repair and the Modified Cold Intolerance Symptom Severity Questionnaire. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e551. [PMID: 26893976 PMCID: PMC4727703 DOI: 10.1097/gox.0000000000000522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The goal of this study was to assess the long-term arterial patency of repaired arteries in the upper extremity and any morbidity resulting from the subsequent occlusion of these vessels. Concurrently, a new questionnaire, the modified Cold Intolerance Symptom Severity (mod CISS) questionnaire, was developed to allow for better assessment of cold intolerance. METHODS Thirteen patients who had undergone repair of the radial (4 patients), ulnar (6 patients), brachial (1 patient), digital (1), and an undefined lower arm artery (1) were examined using questionnaires, physical examination, and high-resolution ultrasound. RESULTS Outcome measures that were statistically significantly worse in the group of patients who presented with nerve injuries included cold intolerance symptoms, Disabilities of the Arm, Shoulder, and Hand score, Michigan Hand Questionnaire, and grip strength (middle setting on dynamometer). The results from the mod CISS correlated with high statistical significance with the results of the CISS score for the injured hand. Of note, wrist extension was significantly better with patent arteries. CONCLUSIONS Sixty-seven percent of arterial repairs remained patent at 6 years (mean) follow-up. The presence of nerve injury has a higher impact on the outcome metrics assessed in this study than arterial patency. Our modification of the CISS score enhances its utility as a survey of cold intolerance.
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Affiliation(s)
- Bernd Lannau
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Jacqueline Bliley
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Isaac B. James
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Sheri Wang
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Wesley Sivak
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Kang Kim
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - John Fowler
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Alexander M. Spiess
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
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Brachial vessel injuries: high morbidity and low mortality injuries. Eur J Trauma Emerg Surg 2011; 37:459. [PMID: 26815416 DOI: 10.1007/s00068-011-0143-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/16/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Reports of arterial injuries from both the civilian and military arenas report the brachial artery as the most frequently injured vessel, accounting for approximately 25-33% of all peripheral arterial injuries. The brachial artery is surrounded by important peripheral nerves -the median, ulnar and radial, and also parallels the humerus and associated veins. Due to its close proximity to these structures, associated nerve and osseous injuries are frequent with residual neuropathy from such nerve injuries, often the main sources of permanent disability. MATERIALS AND METHODS Systematic review of the literature, with emphasis in the diagnosis, treatment and outcomes of these injuries, incorporating the authors experience. CONCLUSIONS The morbidity and mortality rates associated with brachial artery injuries depend on the cause of the injury itself, which vein or tendon is injured, and whether musculoskeletal and nerve injuries are also present. During the last 20 years, amputation associated with upper extremity arterial injuries has decreased to a rate of 3% because of advances in the treatment of shock, the use of antibiotic therapy, and increased surgical experience.
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