Surgical anatomy of the axillary artery: clinical implications for open shoulder surgery

Anatomical Description and Technical Considerations of the Portal of Willingboro for All-Arthroscopic Biceps Tenodesis

The portal of Willingboro is a unique portal designed as a means of all arthroscopic biceps tenodesis for biceps tendinopathy. The portal allows for tenodesis to be efficiently and effectively performed in the subgroove space with low technical demand. This Technical Note provides detailed descriptions of the anatomical structures and standard shoulder arthroscopy portals relevant to the location of the portal of Willingboro. The structures discussed include the standard anterior, posterior, and lateral shoulder arthroscopy portals along with the axillary and musculocutaneous nerves, subscapularis and pectoralis major tendons, axillary artery, and major bony anatomic landmarks of the shoulder region. These descriptions may be used as a guideline or reference for safe creation of the portal of Willingboro.

Percutaneous Cannulation of the Axillary Artery: Does the Position of the Brachial Plexus Correlate With Bony Landmarks That Could Be Used to Reduce the Risk of Complications?

Introduction Endovascular surgery is an innovative way of carrying out procedures such as transcatheter aortic valve insertion where the femoral artery is commonly used as an access point. Conditions like peripheral arterial disease can make endovascular procedures challenging when atherosclerotic plaques compromise the integrity of lower limb vessels. An alternative access point for these patients is required. Access through the axillary artery has been proposed; however, the close proximity of the brachial plexus introduces a risk of neural complications. This study aims to find an anatomical or bony landmark(s) to help identify an area of safety on the axillary artery that can be used to gain access. Materials and methods Nine cadavers were used in the study and five parameters were measured using the acromion and coracoid processes as bony landmarks. The 1st parameter measured the distance between the acromion and the coracoid process. The 2nd parameter was the diameter of the axillary artery taken at a plane extending from the acromion to the coracoid process - now defined as the coracoacromial plane. The 3rd measurement was the distance between the coracoid process and the midpoint of the axillary artery diameter taken at the above plane; it is proposed this will form a safe point on the axillary artery. The 4th parameter measured was the distance between the safe point on the axillary artery and the median nerve. The 5th parameter was the distance between the safe point and the thoracoacromial trunk. Measurements were taken using digital callipers and were recorded for both sides of the cadaver except for one. Using the data from the measurements, an area of safety was calculated and statistical analysis was carried out using Student's t-test and Pearson's correlation to look for significant differences between the left and right sides. Results The mean distance from the safe point of the axillary artery to the median nerve was 23.25 mm on the left and 27.10 mm on the right. The p-value was 0.7, which indicated no significant differences between both sides. The mean distance between the safe point and the thoracoacromial trunk was 11.31 mm on the left and 13.21 mm on the right. The p-value was 0.24, indicating no significant differences between both sides. The mean area of safety was larger on the right side with an area of 184.37 mm and smaller on the left side with an area of 158.93 mm. The p-value was 0.62, which indicated no significant differences between both sides. There was no clear relationship between the distance from the acromion to the coracoid process compared to the distance between the acromion and a defined safe point on the axillary artery. This was confirmed using a Pearson's correlation test, which resulted in a p-value of 0.53 on the left and 0.93 on the right. These values were above the critical value, suggesting no correlation. Conclusion The acromion and the coracoid process are important bony landmarks that can be used to define the coracoacromial plane that traverses the axillary artery whereby avoiding the cords of the brachial plexus, the median nerve as well as the thoracoacromial trunk. Implementing this approach to define a safe vascular access point on the axillary artery could minimise complications like brachial plexus injuries. Further studies on a larger sample size using radiological methods may need to be carried out to help increase confidence in these preliminary cadaveric findings.

Intraoperative and early postoperative complications of reverse shoulder arthroplasty: A current concepts review

Background

Reverse shoulder arthroplasty is a common procedure performed for a variety of shoulder pathologies.

Aims and objectives

This current concept review evaluates the intraoperative and early postoperative complications, with a specific focus given to neurological and vascular injury, fracture, dislocation and venous thromboembolism.

Conclusion

A detailed knowledge of potential complications will allow surgeons to mitigate risk and maximise outcomes.