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Hsu CY, Lo CY. Crutch-induced acute arterial thrombosis. J Vasc Surg Cases Innov Tech 2023; 9:101094. [PMID: 36852316 PMCID: PMC9958051 DOI: 10.1016/j.jvscit.2023.101094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Chan-Yang Hsu
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China,College of Medicine, Tzu Chi University, Hualien City, Taiwan, Republic of China
| | - Chung-Yu Lo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China,College of Medicine, Tzu Chi University, Hualien City, Taiwan, Republic of China
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Crutch-induced brachial artery aneurysm. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Manocha RHK, MacGillivray MK, Eshraghi M, Sawatzky BJ. Injuries Associated with Crutch Use: A Narrative Review. PM R 2020; 13:1176-1192. [PMID: 33094912 DOI: 10.1002/pmrj.12514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/25/2020] [Accepted: 10/05/2020] [Indexed: 11/07/2022]
Abstract
Crutches are commonly prescribed in physiatric settings to help offload the lower extremities. Crutch use, however, results in abnormal and repetitive weight-bearing through the upper extremities that may result in secondary injury. This narrative review investigates injury types and risk factors associated with crutch use in order to guide healthcare providers on injury prevention strategies. Medline, EMBASE, CINAHL, and the Cochrane Library were systematically reviewed for publications between 1950 and 2018 on neurological, musculoskeletal, or vascular complications associated with crutch use. Titles and abstracts (n = 2395) were screened by two authors. Sixty studies were eligible. Articles were reviewed for level of evidence, crutch type, participant characteristics, and injury characteristics. There were 42 axillary crutch studies, 12 forearm crutch studies, and 6 studies that did not specify crutch type. These studies incorporated 622 individuals, and most were case series or case reports (n = 54). Axillary crutch use was most commonly associated with axillobrachial arterial complications due to pressure from the axillary bar (n = 34). Forearm crutch use was most commonly associated with compressive neuropathies due to pressure from the forearm cuff (n = 6). Improper crutch fitting and/or use were identified as contributing factors to injury in 22 cases. Duration of crutch use and medical comorbidities also influenced the types of injuries seen. There are rare but potentially serious complications associated with crutch use. When prescribing crutches, clinicians should ensure they are properly fit, engage in appropriate gait training, be aware of common crutch-related injuries, and consider potential patient-specific injury risk factors in order to minimize injury risk.
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Affiliation(s)
- Ranita H K Manocha
- Division of Physical Medicine & Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | | | - Mehdi Eshraghi
- International Collaboration on Repair Discoveries, Vancouver, Canada
| | - Bonita J Sawatzky
- International Collaboration on Repair Discoveries, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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Ghouri MA, Gupta N, Bhat AP, Thimmappa ND, Saboo SS, Khandelwal A, Nagpal P. CT and MR imaging of the upper extremity vasculature: pearls, pitfalls, and challenges. Cardiovasc Diagn Ther 2019; 9:S152-S173. [PMID: 31559161 DOI: 10.21037/cdt.2018.09.15] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Imaging is needed for diagnosis, treatment planning, and follow-up of patients with pathologies affecting upper extremity vasculature. With growth and evolution of imaging modalities [especially CT angiography (CTA) and MR angiography (MRA)], there is need to recognize the advantages and disadvantages of various modalities and obtain the best possible imaging diagnostic test. Understanding various limitations and pitfalls as well as the best practices to minimize and manage these pitfalls is very important for the diagnosis. This article reviews the upper extremity arterial vascular anatomy, discusses the CTA and MRA imaging, various pitfalls, and challenges and discuss imaging manifestations of upper extremity arterial pathologies.
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Affiliation(s)
- Maaz A Ghouri
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nishant Gupta
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Ambarish P Bhat
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | | | - Sachin S Saboo
- Department of Radiology, UT Health Science Center, San Antonio, TX, USA
| | | | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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Nagpal P, Maller V, Garg G, Hedgire S, Khandelwal A, Kalva S, Steigner ML, Saboo SS. Upper Extremity Runoff: Pearls and Pitfalls in Computed Tomography Angiography and Magnetic Resonance Angiography. Curr Probl Diagn Radiol 2016; 46:115-129. [PMID: 26949062 DOI: 10.1067/j.cpradiol.2016.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/25/2016] [Indexed: 12/13/2022]
Abstract
Upper extremity vasculature can be affected by various traumatic and nontraumatic pathologies; however, the evaluation of these arteries can be challenging for the radiologists as well as for the clinicians. After an accurate history and clinical examination, imaging plays a vital role in the diagnosis and treatment planning of these patients. Depending on the urgency and the indication, upper extremity arteries may be evaluated by ultrasonography with color Doppler, computed tomography (CT), magnetic resonance imaging (MRI), or digital subtraction angiography. This review article discusses relevant imaging anatomy of the upper extremity arteries, presents CT and MRI protocols, briefly describes the state-of-the-art CT and MRI of various pathologies affecting the upper extremity arteries, and summarizes the important pearls needed for busy practicing radiologist.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
| | - Vinod Maller
- Division of Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Gunjan Garg
- Department of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University, New York, NY
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ashish Khandelwal
- Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Sanjeeva Kalva
- Division of Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Michael L Steigner
- Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Sachin S Saboo
- Division of Cardiothoracic Imaging, Department of Radiology, UT Southwestern Medical Center, Dallas, TX
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Leake SS, Sandhu H, Charlton-Ouw KM, Azizzadeh A. Axillary artery thrombosis in a baseball pitcher. J Vasc Surg Cases 2015; 1:168-170. [PMID: 31724563 PMCID: PMC6849898 DOI: 10.1016/j.jvsc.2015.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/17/2015] [Indexed: 12/03/2022] Open
Abstract
Isolated nonatherosclerotic axillary artery disease is a rare condition. External axillary artery compression can result in occlusion or aneurysm formation and subsequent upper extremity ischemia or distal thromboembolism. Chronic compression from use of crutches and repetitive stretching/compression of the axillary artery secondary to overhead motion during high-performance athletic activities are often implicated as the cause. The uniqueness of these lesions and clinical setting requires a high index of suspicion for axillary artery pathology. Prompt diagnosis with arteriography and surgical treatment is necessary given the propensity for thromboembolism. We present a case highlighting this rare phenomenon in a collegiate baseball pitcher.
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Affiliation(s)
- Samuel S Leake
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Tex
| | - Harleen Sandhu
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Tex.,Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart &Vascular Institute, Texas Medical Center, Houston, Tex
| | - Kristofer M Charlton-Ouw
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Tex.,Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart &Vascular Institute, Texas Medical Center, Houston, Tex
| | - Ali Azizzadeh
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Tex.,Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart &Vascular Institute, Texas Medical Center, Houston, Tex
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Kim MH, Hwang JK, Chun HJ, Moon IS, Kim JI. Thrombosed hemodialysis access as an unusual source of emboli in the upper extremity of a kidney transplant recipient. Hemodial Int 2013; 18:535-9. [PMID: 24274072 DOI: 10.1111/hdi.12118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Arteriovenous fistula (AVF) is no longer used in kidney transplant recipients. However, there is no consensus regarding whether or not to ligate a well-functioning AVF after successful kidney transplantation, particularly in patients with well and stably functioning kidney transplants. Most AVFs without complications are left in situ and more than one-third of native AVFs close spontaneously. The currently accepted policy toward thrombosed AVFs is retention within the patient's extremity without treatment. These thrombosed AVFs seldom cause serious problems. However, when combined with aneurysmal dilatation of the proximal vein adjacent to the arterial anastomotic area, the AVF could act as the source of distal arterial emboli. This is very similar clinical scenario to that observed in embolization from a peripheral arterial aneurysm. Here we describe a case report of upper extremity ischemia following massage of a thrombosed aneurysmal AVF. The patient was successfully treated with a combination of catheter-directed thromboaspiration, thrombolysis, and surgical repair of the thrombosed AVF. To the best of our knowledge, this is the first report of upper extremity embolism after massage of a thrombosed aneurysmal AVF involving this combined treatment.
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Affiliation(s)
- Mi-Hyeong Kim
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Furukawa K, Hayase T, Yano M. Recurrent upper limb ischaemia due to a crutch-induced brachial artery aneurysm. Interact Cardiovasc Thorac Surg 2013; 17:190-2. [PMID: 23529749 DOI: 10.1093/icvts/ivt121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
An 83-year old man who had used bilateral axillary crutches for 67 years was referred to our hospital for acute left upper limb ischaemia. He underwent successful recanalization through emergent catheter thromboembolectomy. However, a crutch-induced left brachial artery aneurysm was subsequently detected by computed tomography. Therefore, we performed aneurysm exclusion and subsequent saphenous vein bypass grafting. When a crutch user presents with upper limb ischaemia, a high index of suspicion and early identification of the crutch induced vascular injury are mandatory for appropriate treatment.
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Affiliation(s)
- Kouji Furukawa
- Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.
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Abstract
Contemporary therapies for erectile dysfunction are generally targeted towards older men and universally engage pharmacological and/or device related treatment options. Penile revascularization, using microvascular arterial bypass surgical techniques, is a non-pharmacological, non-device-related, and reconstructive surgical strategy for men with erectile dysfunction that was first described by Dr Vaclav Michal in 1973. Contemporary penile revascularization attempts to 'cure' pure arteriogenic erectile dysfunction in young men with arterial occlusive pathology in the distal internal pudendal, common penile or proximal cavernosal artery secondary to focal endothelial injury from blunt pelvic, perineal or penile trauma. A microvascular anastomosis is fashioned between the donor inferior epigastric and recipient dorsal penile artery. Increased perfusion pressure is theoretically communicated to the cavernosal artery via perforating branches from the dorsal artery. This article will review the history, indications and pathophysiology of blunt trauma-induced focal arterial occlusive disease in young men with erectile dysfunction, current surgical techniques utilized and results of surgery. Contemporary use of penile revascularization is a logical and wanted therapeutic option to attempt to reverse erectile dysfunction in young men who have sustained blunt pelvic, perineal or penile trauma.
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