1
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Oparin AI, Kruglov EV, Karasov IA. [Surgical treatment of a post-traumatic giant pseudoaneurysm of the axillary artery: a case report]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:159-163. [PMID: 33825743 DOI: 10.33529/angio2021109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A false aneurysm of the axillary artery is an extremely rare complication of a lesion of this vessel. As few as several dozens of similar cases have been described in the available literature. We herein report a clinical case concerning surgical treatment of a 41-year-old patient who after a knife-inflicted injury had developed a 66x67 mm pseudoaneurysm of the axillary artery. The treatment consisted of several stages, thus requiring 2 hospitalizations. The first stage included an attempt to resect the aneurysm in an open fashion, followed by deployment of stent grafts in the axillary artery to exclude the aneurysm from circulation. The second stage consisted in elimination of the aneurysmal cavity, followed by decompression of the branches of the brachial plexus and the axillary vein. The patient was discharged on postoperative day 10 after the second surgical intervention.
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Affiliation(s)
- A Iu Oparin
- Department of Cardiovascular Surgery, Municipal Clinical Hospital #4, Perm, Russia
| | - E V Kruglov
- Department of Cardiovascular Surgery, Municipal Clinical Hospital #4, Perm, Russia
| | - I A Karasov
- Department of General Surgery #1, Perm State Medical University named after Academician E.A. Wagner under the RF Ministry of Public Health, Perm, Russia
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2
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Gutkowska O, Martynkiewicz J, Urban M, Gosk J. Brachial plexus injury after shoulder dislocation: a literature review. Neurosurg Rev 2020; 43:407-423. [PMID: 29961154 PMCID: PMC7186242 DOI: 10.1007/s10143-018-1001-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/17/2018] [Accepted: 06/21/2018] [Indexed: 12/01/2022]
Abstract
Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.
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Affiliation(s)
- Olga Gutkowska
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Jacek Martynkiewicz
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Maciej Urban
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Jerzy Gosk
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
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3
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Gowda SR, Hartley R, Allison R, Aarvold A. Paediatric axillary artery pseudo-aneurysm after simple shoulder dislocation. Shoulder Elbow 2018; 10:270-273. [PMID: 30214493 PMCID: PMC6134532 DOI: 10.1177/1758573217693803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/30/2016] [Accepted: 01/11/2017] [Indexed: 11/16/2022]
Abstract
We report the unique case of a 14-year-old male with axillary artery pseudo-aneurysm associated with brachial plexus compression after a simple shoulder dislocation. Following shoulder reduction under anaesthetic, the child was discharged on chemical deep vein thrombosis (DVT) prophylaxis. However, progressive shoulder swelling and upper limb neurological symptoms developed. A multi-disciplinary approach was taken to diagnose and treat this complication. After stopping the anti-coagulants, a combination of endovascular stent-graft and open surgical decompression of the brachial plexus was employed. Paediatric guidelines on DVT prophylaxis are scarce but DVT has never been reported in children following upper limb trauma.
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Affiliation(s)
| | | | | | - Alexander Aarvold
- Poole Hospital NHS Foundation Trust, Poole, UK,Southampton Children’s Hospital, Southampton, UK,Alexander Aarvold, Southampton Children’s Hospital, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK.
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4
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Giannakakis S, Sachmpazidis I, Papapetrou A, Galyfos G, Sachsamanis G, Papacharalampous G, Maltezos C. A Rare Case of Axillary Artery Pseudoaneurysm Due to Shoulder Dislocation Treated With Percutaneous Thrombin Injection. Vasc Endovascular Surg 2018. [DOI: 10.1177/1538574418762653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence of combined neurovascular injuries among patients with high-energy shoulder trauma ranges from 27% to 44%. However, the presentation of an axillary artery pseudoaneurysm (PSA) due to shoulder dislocation without an associated osseous fracture is a very rare condition. Moreover, treatment of combined neurologic and vascular injuries of the shoulder remains controversial. Additionally, minimally invasive treatments such as thrombin injection have been mainly evaluated in patients with iatrogenic femoral artery PSAs. Therefore, we aim to report a rare case of axillary artery PSA associated with brachial plexus injury after shoulder dislocation treated with percutaneous thrombin injection.
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Affiliation(s)
| | | | | | - George Galyfos
- Department of Vascular Surgery, KAT General Hospital, Athens, Greece
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5
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Schumann DR, Superti MJ, Seyboth FC, Jacomel GE. Lesão de plexo braquial secundária a pseudoaneurisma de artéria axilar após luxação glenoumeral: relato de caso. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Schumann DR, Superti MJ, Seyboth FC, Jacomel GE. Brachial plexus injury secondary to pseudoaneurysm of axillary artery after glenohumeral dislocation: case report. Rev Bras Ortop 2017; 52:491-495. [PMID: 28884109 PMCID: PMC5582817 DOI: 10.1016/j.rboe.2017.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022] Open
Abstract
Lesions of the axillary artery and consequent compression of the brachial plexus are extremely rare in patients with glenohumeral dislocation and may have greatly varying clinical manifestations. This joint is one of the most affected by dislocation in the human body, accounting for approximately 45% of cases. Less than 1% of patients with shoulder dislocation have vascular complications; however, when there is damage in the axillary artery, the incidence of associated brachial plexus injury is 27% to 44%. The authors report on a case of brachial plexus compression by an axillary artery pseudoaneurysm after a glenohumeral dislocation, aiming to highlight the existence of this association, in order to make an early diagnosis and avoid serious complications, such as neurologic injury.
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7
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Chehata A, Morgan FH, Bonato L. Axillary artery injury after an anterior shoulder fracture dislocation and "periosteal sleeve avulsion of the rotator cuff" (SARC). Case report and review of the literature. Trauma Case Rep 2017; 8:5-10. [PMID: 29644306 PMCID: PMC5883186 DOI: 10.1016/j.tcr.2017.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 11/05/2022] Open
Abstract
We present the rare complication of an axillary artery injury associated with an anterior dislocation of the humerus and what we believe to be the first reported periosteal sleeve avulsion of the entire rotator cuff (SARC). We review the literature and discuss the cause of this unusual injury pattern.
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Affiliation(s)
- Ash Chehata
- Royal Melbourne Hospital, Melbourne, Australia.,Cabrini Hospital, Malvern, Australia
| | - F Hamish Morgan
- Cabrini Hospital, Malvern, Australia.,Monash University, Melbourne, Australia.,Alfred Health, Alfred Hospital, Melbourne, Australia
| | - Luke Bonato
- Cabrini Hospital, Malvern, Australia.,Monash University, Melbourne, Australia
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8
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Monem M, Iskandarani MK, Gokaraju K. Axillary artery pseudoaneurysm resulting in brachial plexus injury in a patient taking new oral anticoagulants. BMJ Case Rep 2016; 2016:bcr-2016-216976. [PMID: 27535738 DOI: 10.1136/bcr-2016-216976] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We discuss the case of an independent 80-year-old Caucasian woman, being treated with new oral anticoagulants for a previous deep vein thrombosis, who had fallen on her right shoulder. She made a delayed presentation to the emergency department with a wrist drop in her right dominant hand. She had right arm bruising with good distal pulses but had a global neurological deficit in the hand. Plain radiographs of the shoulder, humerus, elbow, forearm and wrist demonstrated no fractures. MRI showed a significant right axillary lesion distorting the surrounding soft tissues, including the brachial plexus, and CT with contrast confirmed this to be a large axillary pseudoaneurysm. This was treated with an endovascular stent resulting in slightly improved motor function, but the significant residual deficit required subsequent rehabilitation to improve right upper limb function.
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Affiliation(s)
- Mohammed Monem
- Trauma & Orthopaedic Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | | | - Kishan Gokaraju
- Trauma & Orthopaedic Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
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9
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Zaraa M, Sehli H, Mahjoub S, Dridi M, Mbarek M. Double level arterial injury with neuropraxia following anterior shoulder dislocation. J Clin Orthop Trauma 2015; 6:277-80. [PMID: 26566344 PMCID: PMC4600840 DOI: 10.1016/j.jcot.2015.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 04/24/2015] [Indexed: 11/16/2022] Open
Abstract
Vascular and nervous complications are rare after shoulder dislocation. We report the case of a double level arterial injury with neuropraxia following anterior shoulder dislocation that was diagnosed by MultiDetector-row Computed Tomographic (MDCT) angiography and treated by surgical bypass graft and embolectomy. Our case is original, not only because of the rarity of these complications, but also because of the thromboembolism of brachial artery which could be undiagnosed and could compromise prognosis.
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Affiliation(s)
- Mourad Zaraa
- Corresponding author. Tel.: +216 20346501; fax: +216 98346501.
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10
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Chen L, Peng F, Wang T, Chen D, Yang J. Traumatic pseudoaneurysm of axillary artery combined with brachial plexus injury. PLoS One 2014; 9:e113099. [PMID: 25412426 PMCID: PMC4239043 DOI: 10.1371/journal.pone.0113099] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 10/19/2014] [Indexed: 11/19/2022] Open
Abstract
Traumatic pseudoaneurysm of the axillary artery combined with brachial plexus injury is extremely rare. The factors that influence the symptoms and functional recovery related to this condition are unclear. Nine patients who had sustained this trauma were surgically treated at our unit between June 1999 and November 2010. The cause of trauma, symptoms, signs and examinations of neurological and vascular deficits, and the surgical findings of the involved nerves and vessels were recorded in detail. The functional recovery of vessels and nerves, as well as the extent of pain, were evaluated, respectively. The average length of patient follow-up was 4.5 years (range, 24 months to 11.3 years). After vessel repair, whether by endovascular or operative treatment, the distending, constant, and pulsating pain was relieved in all patients. Furthermore, examination of the radial artery pulse on the repaired side appeared normal at last follow-up. All patients showed satisfactory sensory recovery, with motor recovery rated as good in five patients and fair in four patients. The symptom characteristics varied with the location of the damage to the axillary artery. Ultrasound examination and computed tomography angiography are useful to evaluate vascular injury and provide valuable information for operative planning. Surgical exploration is an effective therapy with results related to the nerve injury condition of the brachial plexus.
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Affiliation(s)
- Lin Chen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
- Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Feng Peng
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
- Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
- * E-mail:
| | - Tao Wang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
- Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Desong Chen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
- Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Jianyun Yang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
- Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
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11
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Abstract
Proximal humerus fractures have rarely been associated with injuries to the axillary artery. Most of the fractures described have been Neer 2-part surgical neck fractures with medialization of the shaft fragment and resultant laceration or thrombosis of the axillary artery. No intraoperative deaths have been reported. We present a series of 3 proximal humerus fractures, 2 of which are Neer 3- to 4-part anterior fracture dislocations, and associated axillary artery injury. There were 2 mortalities, 1 intraoperative. After a thorough review of the English literature, we identified an additional 11 cases of axillary artery injury associated with proximal humerus fracture. The purpose of this study was to heighten the clinical suspicion of this vascular injury in patients with proximal humerus fracture dislocations and surgical neck fractures with shaft medialization, as well as to review pathogenesis and guide management decisions.
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12
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Iakovlev M, Marchand JB, Poirier P, Bargoin K, Gouëffic Y. Posttraumatic Axillary False Aneurysm after Luxatio Erecta of the Shoulder: Case Report and Literature Review. Ann Vasc Surg 2014; 28:1321.e13-8. [DOI: 10.1016/j.avsg.2014.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/01/2013] [Accepted: 01/03/2014] [Indexed: 11/17/2022]
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13
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Nour M, Zerhouni H, Bensaid B, Khaloufi S, Ouazzani L, Aqquaoui L, Elhami I, Oubejja H, Erraji M, Ettayebi F. [Axillary artery pseudo-aneurysm secondary to shoulder dislocation in children]. ACTA ACUST UNITED AC 2013; 38:377-80. [PMID: 24042011 DOI: 10.1016/j.jmv.2013.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022]
Abstract
Axillary artery injury following anterior dislocation of the shoulder in children is a rare complication often considered as iatrogenic. We report the case of a pseudo-aneurysm of the axillary artery in a 5-year-old boy that appeared four months after a shoulder dislocation that was reduced in an ambulatory setting. Although this is an uncommon vascular complication, we emphasize the need for short-term and long-term follow-up in these children to avoid missing a pseudo-aneurysm of the axillary artery.
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Affiliation(s)
- M Nour
- Service des urgences chirurgicales pédiatriques, hôpital d'Enfant-Rabat, Rabat, Maroc.
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14
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Dympep B, Khangarot S, Hadke N. An unusual presentation of traumatic pseudoaneurysm of axillary artery mimicking soft tissue tumor. J Surg Case Rep 2012; 2012:17. [PMID: 24960757 PMCID: PMC3649656 DOI: 10.1093/jscr/2012.10.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Traumatic pseudoaneurysm of the axillary artery is a rare sequela of injury to shoulder region. We report here a unique case of delayed presentation of axillary artery pseudoaneurysm after a blunt injury, clinically mimicking soft tissue tumor without evidence of gross bony injury. The gentleman presented after six months of injury with a progressively growing mass in left axillary region and neurological deficit. Ultimate management of the lesion was surgical resection and Saphenous vein graft interpositioning. Unfortunately the lack of subsequent neurological recovery parallels some of the findings in the literature, from cases where decompression of the brachial plexus was not undertaken soon enough.
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Affiliation(s)
- B Dympep
- Maulana Azad Medical College, New Delhi, India
| | - S Khangarot
- Maulana Azad Medical College, New Delhi, India
| | - N Hadke
- Maulana Azad Medical College, New Delhi, India
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15
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Delayed Axillary Artery Pseudoaneurysm as an Isolated Consequence to Anterior Dislocation of the Shoulder. Ann Vasc Surg 2012; 26:279.e9-12. [DOI: 10.1016/j.avsg.2011.05.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 04/22/2011] [Accepted: 05/15/2011] [Indexed: 11/22/2022]
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16
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Abstract
Traumatic pseudoaneurysm of the axillary artery is a rare sequel of shoulder injury. We report here a unique phenomenon of delayed presentation axillary pseudoaneurysm some time after an initial blunt injury, with no evidence of gross bony injury. The gentleman presented again some weeks later after a failure of rehabilitation and progressive neurological deficit in the affected arm. Ultimate management of the lesion was by endovascular insertion of a covered stent, and decompression of the axilla. Unfortunately the lack of subsequent neurological recovery parallels some of the findings in the literature, from cases where relief of the brachial plexus was not undertaken soon enough.
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Affiliation(s)
- Aj Moss
- Queen Elizabeth Hospital, Norfolk, UK
| | - D Valenti
- Queen Elizabeth Hospital, Norfolk, UK
| | - Sc Fraser
- Queen Elizabeth Hospital, Norfolk, UK
| | - J Murie
- Queen Elizabeth Hospital, Norfolk, UK
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17
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Kosiyatrakul A, Jitprapaikulsarn S, Durand S, Oberlin C. Recovery of brachial plexus injury after shoulder dislocation. Injury 2009; 40:1327-9. [PMID: 19540487 DOI: 10.1016/j.injury.2009.05.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 05/14/2009] [Accepted: 05/15/2009] [Indexed: 02/02/2023]
Abstract
Brachial plexus injury is an underestimated complication from anterior dislocation of the shoulder. To our knowledge, there is limited information available about the factors that influence neurological recovery of this injury. We reviewed 15 upper extremities in 14 patients with brachial plexus injuries caused by anterior shoulder dislocation. Two-thirds of the cases had total brachial plexus palsy. With the conservative treatment, the motor recoveries of all cases are full or nearly full within 20 months except intrinsic muscle of the hand. Intrinsic muscle recovery may be better in a younger age group (less than 50 years). Nerve exploration is usually unnecessary. However, reconstructive surgery for the residual neurological deficit can provide improvement of hand function.
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Affiliation(s)
- Arkaphat Kosiyatrakul
- Department of Orthopedic Surgery, Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.
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18
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Kumar RM, Reddy SS, Sharma R, Mahajan R, Talwar KK. Endovascular repair of a traumatic axillary artery pseudoaneurysm. Cardiovasc Intervent Radiol 2009; 32:598-600. [PMID: 19296160 DOI: 10.1007/s00270-009-9543-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Revised: 12/28/2008] [Accepted: 01/06/2009] [Indexed: 11/26/2022]
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19
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Mathieu L, Chetboun A, Nourissat G, Doursounian L. [Rupture of axillary artery and brachial plexus paralysis as complications of recurrent anterior glenohumeral dislocation: a case report]. CHIRURGIE DE LA MAIN 2009; 28:103-6. [PMID: 19261504 DOI: 10.1016/j.main.2009.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 12/23/2008] [Accepted: 01/18/2009] [Indexed: 11/25/2022]
Abstract
The authors report a case of transection of the axillary artery and brachial plexus paralysis following recurrent anterior glenohumeral dislocation. Subsequent vascular reconstruction was performed using a venous interposition graft. The brachial plexus was explored at the same time and found to be in continuity. Neurological recovery was complete within a few months.
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Affiliation(s)
- L Mathieu
- Service de chirurgie orthopédique et traumatologie, hôpital Saint-Antoine, 75012 Paris, France.
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20
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Inui A, Kokubu T, Fujioka H, Toyokawa N, Nakagiri K, Doita M, Kurosaka M. Shoulder fracture dislocation associated with axillary artery injury: a case report. J Shoulder Elbow Surg 2008; 18:e14-6. [PMID: 19062312 DOI: 10.1016/j.jse.2008.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 06/04/2008] [Accepted: 07/07/2008] [Indexed: 02/01/2023]
Affiliation(s)
- Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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21
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Bravman JT, Ipaktchi K, Biffl WL, Stahel PF. Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential "near miss" injuries. Scand J Trauma Resusc Emerg Med 2008; 16:16. [PMID: 19032757 PMCID: PMC2637899 DOI: 10.1186/1757-7241-16-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 11/25/2008] [Indexed: 11/26/2022] Open
Abstract
Background Low energy trauma to the upper extremity is rarely associated with a significant vascular injury. Due to the low incidence, a high level of suspicion combined with appropriate diagnostic algorithms are mandatory for early recognition and timely management of these potentially detrimental injuries. Methods Review of the pertinent literature, supported by the presentation of two representative "near miss" case examples. Results A major diagnostic pitfall is represented by the insidious presentation of significant upper extremity arterial injuries with intact pulses and normal capillary refill distal to the injury site, due to collateral perfusion. Thus, severe vascular injuries may easily be missed or neglected at the upper extremity, leading to a long-term adverse outcome with the potential need for a surgical amputation. Conclusion The present review article provides an outline of the diagnostic challenges related to these rare vascular injuries and emphasizes the necessity for a high level of suspicion, even in the absence of a significant penetrating or high-velocity trauma mechanism.
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Affiliation(s)
- Jonathan T Bravman
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA.
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22
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Diagnosis and management of vascular injuries in the shoulder girdle of the overhead athlete. Curr Sports Med Rep 2008. [DOI: 10.1007/s11932-007-0070-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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24
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McCann PA, Barakat MJ, Wand JS. Delayed brachial plexus compression secondary to anterior shoulder dislocation—The late consequence of an axillary artery pseudoaneurysm: A case report. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.injury.2006.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Stahnke M, Duddy MJ. Endovascular Repair of a Traumatic Axillary Pseudoaneurysm Following Anterior Shoulder Dislocation. Cardiovasc Intervent Radiol 2005; 29:298-301. [PMID: 16283573 DOI: 10.1007/s00270-005-0071-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pseudoaneurysms due to musculoskeletal trauma are rare and comprise less than 2% of all pseudoaneurysms. We report a case of axillary pseudoaneurysm following anterior dislocation of the shoulder. The patient was successfully treated by endovascular intervention.
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Affiliation(s)
- Michaela Stahnke
- Department of Radiology, Selly Oak Hospital, University Hospital Birmingham Foundation Trust, Raddlebarn Road, Birmingham, B29 6JD, UK
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26
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Abstract
We present a case of a 68-year-old female patient who had an interscalene nerve block (ISB) complicated by compression of her brachial plexus by a pseudoaneurysm. The complication occurred after the patient received an ISB as anesthesia for an outpatient shoulder procedure. Review of this complication should alert surgeons to consider this diagnosis as a possibility in patients with postoperative pain and/or neurologic compromise after receiving an ISB.
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Affiliation(s)
- G Adam Flowers
- Orthopaedic Research of Virginia, Richmond, Virginia, USA.
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