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Huri G, Aksoy T, Beydemir A, Yigit YA, Yilmaz M. Axillary Artery Transection and Brachial Plexus Injury After Open Inferior Glenohumeral Dislocation: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00019. [PMID: 37094023 DOI: 10.2106/jbjs.cc.22.00703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
CASE A judo athlete presented with an open inferior shoulder dislocation that occurred during competition. Examination revealed a transection of the axillary artery and neuropraxia of the posterior cord. Neuropraxia was resolved within 2 weeks. The axillary artery was repaired with a femoral vein graft. He regained full strength, range of motion, and function at 8 months. CONCLUSION Inferior glenohumeral dislocations are rare, and their management can be complicated by vascular and neurological injuries. We emphasize the importance of examination, diagnosis, and treatment of neurovascular pathologies to avoid catastrophic outcomes.
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Affiliation(s)
- Gazi Huri
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
| | - Taha Aksoy
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
| | - Ataberk Beydemir
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
| | - Yigit Aras Yigit
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
| | - Mustafa Yilmaz
- Department of Cardiovascular Surgery, Hacettepe University Hospitals, Ankara, Turkey
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Grzeda AL, Hicks AC, Cheadle GA, Sangroula D, Wayne EJ, Dwivedi AJ, Sigdel A. Endovascular Repair of Transected Axillary Artery via Snare Assisted Through and Through Femoral to Brachial Artery Access. Am Surg 2022; 88:1543-1545. [PMID: 35337191 DOI: 10.1177/00031348221083936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Axillary artery injury is a rare but complex surgical problem that often requires challenging exposures, lengthy operations, and morbid outcomes for repair. For these reasons, endovascular repair is an attractive alternative as it obviates many of the challenges present with open repair. While pseudoaneurysms, dissections, and short segment injuries with limited arterial disruption are regularly treated endovascularly, complete arterial transections are almost exclusively treated with open repair as obtaining wire access across the site of injury is often not possible. Here we report a case of successful endovascular repair of a completely transected axillary artery with the use of snare assistance to obtain through and through femoral to brachial artery access. This ultimately allowed for covered stent deployment across the axillary transection restoring distal blood flow. Snare assistance in obtaining through and through access across areas of complete transection can allow for increased use of endovascular repair.
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Affiliation(s)
- Anthony L Grzeda
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Adam C Hicks
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Gerald A Cheadle
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Daisy Sangroula
- Department of Anesthesiology, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Erik J Wayne
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Amit J Dwivedi
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Abindra Sigdel
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
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Valdivia Zúñiga CA, Fulvi AN. Fatal Outcome After Reduction of a Superior Shoulder Dislocation, A Case Report and Literature Review: A Case Report and Literature Review. JBJS Case Connect 2021; 11:01709767-202109000-00076. [PMID: 35102041 DOI: 10.2106/jbjs.cc.21.00128] [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: 06/14/2023]
Abstract
CASE An 81-year-old woman presented a superior glenohumeral dislocation after a low-energy fall, with a mechanism of axial load while the shoulder was in adduction and extension. After successful closed reduction, the patient presented sudden symptoms of severe vascular injury with a protruding axillary hematoma and hypovolemic shock. CONCLUSION Superior shoulder dislocations and vascular injuries are extremely rare among shoulder dislocations, especially after low-energy trauma. Vascular injuries may result in limb compromise and death. We highlight the importance of high clinical suspicion, particularly in superior dislocations, and the importance of prompt management of vascular complications to avoid catastrophic outcomes.
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Liu J, Dong S, Wang J, Liu H, Wu Y, Rui Y. <p>Upper Limb Salvage of a Mangled Limb with Reconstruction of Brachial, Ulnar and Radial Arteries Using an Extremely Long Reversed Bifurcated Great Saphenous Vein: A Case Report with Long-Term Follow-Up</p>. Int J Gen Med 2020; 13:1235-1241. [PMID: 33262639 PMCID: PMC7700002 DOI: 10.2147/ijgm.s280616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
Acute elbow dislocation complicated by arterial injury of upper limb is rare but serious injury. We present the case about destructive injury of brachial, ulnar, and radial arteries with an open posterior dislocation of the right elbow, and a 25cm long reversed bifurcated great saphenous vein graft was applied for arterial reconstruction. The patient had obvious distal pulses after the operation. Ten years’ follow-up showed the good function of the right arm. Using an extremely long vein graft for the upper limb arterial reconstruction is challenging but feasible and provides good results.
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Affiliation(s)
- Jun Liu
- Department of Orthopedics, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, People’s Republic of China
| | - Sheng Dong
- Department of Orthopedics, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, People’s Republic of China
| | - Jianbing Wang
- Department of Orthopedics, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, People’s Republic of China
| | - Hao Liu
- Department of Orthopedics, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, People’s Republic of China
| | - Yongwei Wu
- Department of Orthopedics, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, People’s Republic of China
| | - Yongjun Rui
- Department of Orthopedics, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, People’s Republic of China
- Correspondence: Yongjun Rui Department of Orthopedics, Wuxi No.9 People’s Hospital Affiliated to Soochow University, 999 Liangxi Road, Wuxi, People’s Republic of China Email
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Kee-Sampson J, Eadie E, Matteo J, Shabandi N, Meyer T, Bashir S. Mind the gap: A novel endovascular technique to repair a transected vessel. Vascular 2020; 28:436-440. [PMID: 32089108 DOI: 10.1177/1708538120905736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Level one trauma centers experience horrific injuries on a regular basis. Blunt or penetrating trauma causing vascular injuries are treated by surgeons and interventional radiologists. When a blood vessel is completely transected, the ends of the vessel retract and vasospasm occurs as a normal survival response. When this phenomenon occurs, it is sometimes impossible to reattach the two ends of the injured vessel by surgical means and a bypass graft is often required. However, from an endovascular perspective, covered stents can serve as a vascular bypass as well. The limiting factor with an endovascular approach is the ability to successfully gain wire access across the injured vessel. The technique described in this manuscript describes a "rendezvous" method of repairing a transected axillosubclavian artery from a high-speed motorcycle accident using a steerable microcatheter. Initially, multiple failed attempts to cross the injured vessel were encountered despite using a wide variety of conventional guidewires and catheters. A steerable microcatheter was then used to safely and effectively navigate more than 15 cm through soft tissue to the opposite end of the vessel. In this critically ill patient, this technique significantly reduced the procedural time when compared to our previous experiences repairing arterial transections using traditional catheters.
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Affiliation(s)
- Joanna Kee-Sampson
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Erik Eadie
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Jerry Matteo
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Naudare Shabandi
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Travis Meyer
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Saeed Bashir
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
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Cawley OV, Walsh AS, Asghar I, Desmarowitz HU, Antoniou GA. Arterial Injury in the Upper Limb Resulting from Dog Bite. Ann Vasc Surg 2018; 49:314.e5-314.e10. [PMID: 29481925 DOI: 10.1016/j.avsg.2017.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 11/09/2017] [Accepted: 11/19/2017] [Indexed: 11/27/2022]
Abstract
Dog bites in the upper limbs have particular significance, because despite the small size of the puncture wounds, penetration is deep, causing serious injuries to deeper structures. There is currently very little data relating to upper extremity dog bite arterial injury. We present the case of a 32-year-old man who sustained a dog bite injury to his right arm, leading to direct puncture and spasm of the brachial artery. He was successfully treated with a jump bypass graft to the right brachial artery, with the use of the reversed ipsilateral cephalic vein as a conduit. We identified 34 cases in the literature reporting upper limb arterial injury secondary to dog bite. Twenty-two cases in the literature detailed axillobrachial artery damage (65%), 24% radial artery, 3% ulnar artery, and 9% combined. Presentation was most commonly with diminished pulses found in at least 45% of the patients. Arterial thrombosis occurred in 29% of cases of single artery injury, transection in 15%, intimal tear in 9% of cases, and undisclosed in 44%. Management most commonly included interposition graft (47%) and primary repair (20%), while 15% did not undergo surgical intervention, 9% underwent ligation, and 3% were treated with thromboembolectomy. Follow-up data for these patients are scarce, with some experiencing residual neurological deficit. This report highlights the importance of prompt recognition and treatment of vascular injury following dog bite to attain an optimal outcome and minimize complications.
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Affiliation(s)
- Oliver Vincent Cawley
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.
| | - Anna S Walsh
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Imran Asghar
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Hans U Desmarowitz
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
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Lebowitz C, Matzon JL. Arterial Injury in the Upper Extremity: Evaluation, Strategies, and Anticoagulation Management. Hand Clin 2018; 34:85-95. [PMID: 29169600 DOI: 10.1016/j.hcl.2017.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Trauma to the upper extremity can present with an associated arterial injury. After patient stabilization, thorough assessment with physical examination and various imaging modalities allows accurate diagnosis of the specific arterial injury. After diagnosis, efficient treatment is necessary to allow limb salvage. Treatment options include ligation, primary repair, graft reconstruction, endovascular repair, and amputation. The final treatment rendered is frequently dependent on injury location and mechanism. With any of the treatment options, complications may occur, including thrombosis. Currently, no validated anticoagulation protocol has been established for managing arterial injuries in the upper extremity.
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Affiliation(s)
- Cory Lebowitz
- Department of Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ 080084, USA
| | - Jonas L Matzon
- Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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Leclerc B, Loisel F, Ferrier M, Al Sayed M, Rinckenbach S, Obert L. Axillary artery transection and bilateral pulmonary embolism after anterior shoulder dislocation: case report. SICOT J 2017; 3:3. [PMID: 28074775 PMCID: PMC5225835 DOI: 10.1051/sicotj/2016041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/19/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction: Anterior shoulder dislocation can be associated with vascular and neurological complications. However, axillary artery injury associated with shoulder dislocation is rare and extremely rare without bone fracture. An early diagnosis of these complications allows predicting long-term functional outcomes. Methods: This article reports the case of a 66-year-old patient who presented an anterior shoulder dislocation after a ski fall without any neurological dysfunction or pulse deficit. Results: The first reduction attempts were unsuccessful and during the new attempt, we observed a hematoma. A CT scan showed a disruption of the axillary artery and a bilateral pulmonary embolism. Conclusion: Neurovascular injury must be systematically sought before and after reduction, and a multidisciplinary approach is always necessary.
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Affiliation(s)
- Betty Leclerc
- Vascular Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
| | - François Loisel
- Orthopaedic, Traumatology and Hand Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Maxime Ferrier
- Orthopaedic, Traumatology and Hand Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Mazen Al Sayed
- Vascular Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Simon Rinckenbach
- Vascular Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Laurent Obert
- Orthopaedic, Traumatology and Hand Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
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Brachial Artery Reconstruction in Trauma Using Reversed Arm Vein from the Injured Upper Limb. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1034. [PMID: 27826464 PMCID: PMC5096519 DOI: 10.1097/gox.0000000000001034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/22/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Brachial artery repair may be technically challenging with a paucity of guidelines. The use arm vein (AV) from the traumatized limb is herein described. METHODS Data were prospectively collected from 2002 to 2016 on brachial artery injury including age, sex, mechanism/site of injury, and repair technique. Categories included AV and non-arm vein (NAV) groups. One-year outcomes were noted. RESULTS All 31 cases studied were of men with an age range of 16 to 73 years (mean = 28). Injuries included 13 gunshots, 7 stabbings, 6 glass injuries, 2 dislocated elbows, 1 crush, 1 impalement, and 1 avulsion. Site of injuries included the antecubital region in 25, midbrachial in 5, and proximal brachial in 1, with 4 associated fractures. Repair was done using reversed AV from the traumatized limb in 15 cases and NAV in 16. In the AV group, the adjacent basilic vein was used in 9 cases, the adjacent cephalic vein in 3, and the distal (or wrist area) cephalic vein in 3. The limb salvage rates in the AV versus NAV groups were 100% and 94%, respectively (Fisher's exact t test, P = 1.00), with no major technique-related complications. CONCLUSIONS The outcomes of using reversed AV from the traumatized limb are equivalent to those of other standard techniques such as primary repair, polytetrafluoroethylene, or reversed great saphenous vein, with a 1-year limb salvage rate of 100%. Additionally, advantages include decreased wound complications, better vein graft--artery caliber match, and shorter operating times while maintaining acceptable patency rates.
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