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Berrio-Caicedo JJ, Arroyave CD, Burgos-Rueda HA. Gunshot-related giant brachial artery pseudoaneurysm: Case report. Trauma Case Rep 2022; 38:100610. [PMID: 35141389 PMCID: PMC8816716 DOI: 10.1016/j.tcr.2022.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Pseudoaneurysms are late and rare complications in the upper limbs due to penetrating vascular trauma. Although endovascular management is offered as the ideal approach, there are some anatomical conditions to consider surgical treatment. An 18-year-old patient was admitted into our hospital two months later after suffering a single gunshot on the left arm. The arteriography showed loss of most of the branchial artery (BA) course, which was replaced by an unusual 14 ∗ 10 cm pseudoaneurysm. The increasing deformity within the anterior compartment of the arm generated neuropathic and ischemic symptoms (NIS) that were resolved after the drainage and reconstruction of BA. An autologous, ipsilateral basilic vein (BV) graft was used for this purpose. After 26 months, the normal hemodynamic conditions of the treated limb allowed the patient to remain asymptomatic.
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Affiliation(s)
- Jhon Jairo Berrio-Caicedo
- Department of Vascular Surgery, Fundación Hospital San José de Buga, Buga, Colombia
- Department of General Surgery, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia
- Department of General Surgery, Clínica Imbanaco Cali, Colombia
- Corresponding author at: Departamento de Cirugía Vascular, Fundación Hospital San José de Buga, Carrera 8 # 17 - 52, Guadalajara de Buga, Valle del Cauca, Colombia.
| | - Cristhian David Arroyave
- Department of General Surgery, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia
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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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Keck KJ, Adams TJ, Day KM. Radial Recurrent Artery: Autologous Patch Graft for Acute Brachial Artery Laceration. Cureus 2020; 12:e10682. [PMID: 33133848 PMCID: PMC7593123 DOI: 10.7759/cureus.10682] [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: 08/13/2020] [Accepted: 09/15/2020] [Indexed: 11/06/2022] Open
Abstract
Brachial artery injury is the most common vascular disruption in upper extremity penetrating trauma, usually treated by primary repair or saphenous vein interposition graft. We report the case of a young male who presented after assault with stab wound to the right antecubital fossa, an asymmetric vascular exam, and unknown depth contaminated wound that warranted operative exploration. We performed open exploration through a triangular flap extension of his oblique linear laceration for both exposure and flexor surface scar contracture prophylaxis. Exploration revealed brachial artery laceration with loss of approximately 30% of vessel circumference proximal to the radial and ulnar artery bifurcation. A near-complete transection of the recurrent radial artery was also present, leading to the decision to sacrifice this vessel for use as an autologous patch graft of the injured brachial artery. Distal vascular flow was re-established, and the vessel was slightly ectatic with no evidence of stenosis. Patient suffered no complications and was discharged at post-operative day four after perioperative heparin drip on anti-platelet therapy. Autologous patch grafting in the acute setting is a less-often considered surgical option that is effective for arterial bifurcation reconstruction, which may be employed through the sacrifice of injured and redundant local branch vessels. Patch grafts are commonly utilized in planned vascular surgery, such as carotid endarterectomy, but this is the first report of autologous patch graft to an acute brachial artery injury. By combining knowledge of the lateral arm flap with the plastic surgery principles of "like replaces like", this technique avoids the stenosis associated with primary repair, the multiple anastomoses necessary for interposition grafting, the need for a secondary donor site, and provides a theoretical blood-flow advantage.
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Affiliation(s)
- Kendall J Keck
- Plastic Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Thomas J Adams
- Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Kristopher M Day
- Plastic Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA
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Abubakar A, Okpechi S. Bilateral vascular repair in a patient with multiple upper extremity injury presenting at a teaching hospital—Case report and literature review. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:30-35. [PMID: 35814970 PMCID: PMC9267045 DOI: 10.4103/jwas.jwas_7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
Penetrating trauma to the upper extremity will usually result in vascular injuries, which mostly also involves nerves and tendons. Morbidity related to upper extremity vascular injuries usually occurs due to the associated injuries of the nerves, tendons, and bone. Early presentation to a trauma centre and prompt intervention will reduce morbidity associated with upper extremity vascular injuries.
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Senefonte FRDA, Rosa GRDPS, Comparin ML, Covre MR, Jafar MDB, Andrade FAMD, Maldonado Filho G, Nogueira Neto E. Amputação primária no trauma: perfil de um hospital da região centro-oeste do Brasil. J Vasc Bras 2012. [DOI: 10.1590/s1677-54492012000400004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXTO: Vivemos num período de epidemia do trauma. A amputação de indicação traumática incide em uma população jovem e economicamente ativa com repercussão onerosa no âmbito socioeconômico, tornando-se um problema de saúde pública. OBJETIVOS: Conhecer a casuística de amputações traumáticas realizadas na Santa Casa de Campo Grande-MS, entre 2005 e 2008. MÉTODOS: Estudo de prevalência, descritivo, longitudinal e retrospectivo. Amostragem de conveniência, realizada com revisão sistemática de prontuários de pacientes submetidos a amputações de membros inferiores e/ou superiores cuja indicação foi trauma incompatível com reconstrução. Foram excluídos os pacientes que já chegaram amputados no pronto-socorro. Avaliaram-se nível de amputação, faixa etária, sexo e escala do sistema MESS para indicação de amputação traumática. Utilizaram-se o teste quiquadrado e o teste exato de Fisher, considerando um intervalo de confiança de 95%. RESULTADOS: Foram realizadas 108 amputações no período, na faixa etária de dois anos a 78 anos, com média de 36,7 ± 12 anos e mediana de 35 anos. Houve predomínio do sexo masculino em 72% da casuística. O nível de amputação mais executado foi de amputações menores (pododáctilos e quirodáctilos). A causa mais frequente foi lesão decorrente de acidente de trânsito. CONCLUSÕES: As amputações traumáticas atingiram uma população jovem e produtiva, conforme corroborado pela literatura, com predomínio de acidentes de trânsito com lesões ortopédicas e neurológicas associadas.
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Abstract
BACKGROUND AND OBJECTIVE The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability. The purpose of our study was to review our experience with brachial artery injuries over a 9-year period, describing the type of injury, surgical procedures, complications, and associated injuries. PATIENTS AND METHODS Forty-nine patients with brachial artery injury underwent surgical repair procedures at our hospital, from the beginning of May 1999 to the end of June 2008. The brachial artery injuries were diagnosed by physical examination and Doppler ultrasonography. Depending on the mode of presentation, patients were either taken immediately to the operating room for bleeding control and vascular repair or were assessed by preoperative duplex ultrasonography. RESULTS This study group consisted of 43 males and 6 females, ranging in age from 6 to 65 years with a mean (SD) age of 27.9 (6.7) years. The mechanism of trauma was penetrating in 45 patients and blunt in the remaining 4 patients. Stab injury was the most frequent form of penetrating trauma (24 of 45). Treatment included primary arterial repair in 5 cases, end-to-end anastomosis in 28 cases, interposition vein graft in 15 cases, and interposition-ringed polytetrafluoroethylene graft in 1 case. Associated injuries were common and included venous injury (14), bone fracture (5), and peripheral nerve injury (11). Fifteen patients developed postoperative complications. One patient underwent an above-elbow amputation. CONCLUSIONS Prompt and appropriate management of the brachial artery injuries, attention to associated injuries, and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage.
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Affiliation(s)
- Hasan Ekim
- Department of Cardiovascular Surgery and Cardiology, Yüzüncü Yil University, Van, Turkey.
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Seidel AC, Nagata AK, Almeida HCD, Bonomo M. Epistemologia sobre amputações e desbridamentos de membros inferiores realizados no Hospital Universitário de Maringá. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009005000002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTO: Não há estatísticas precisas sobre o número de amputações realizadas anualmente, mas é conhecido o comprometimento da qualidade de vida desses indivíduos e a necessidade de uma equipe multiprofissional para sua reabilitação. OBJETIVO: Analisar todas as amputações de membros inferiores realizadas pelo Serviço de Angiologia e Cirurgia Vascular do Hospital Universitário Regional de Maringá entre 2000 e 2006. MÉTODOS: Estudo descritivo e retrospectivo a partir dos prontuários de pacientes submetidos a amputação ou desbridamento cirúrgico de membros inferiores por trauma ou doença vascular. RESULTADOS: Ocorreram 116 procedimentos, sendo 84,5% amputações e 15% desbridamentos cirúrgicos, em 111 pacientes, sendo 78 homens e 33 mulheres, cuja média das idades foi de 63,4 anos (4 a 100 anos), sendo os principais fatores etiológicos: doenças vasculares (92,8%) e trauma (7,2%). As comorbidades e fatores de risco mais prevalentes foram: hipertensão arterial sistêmica (66%), diabetes melito (60%), tabaco (28%) e arritmia cardíaca (0,9%). Quanto à escolaridade, se observou que 52,2% dos pacientes cursaram apenas o ensino fundamental, 6,5% fizeram o ensino médio, completo ou incompleto, e 41,3% eram analfabetos. A percentagem de pacientes submetidos à amputação primária foi de 94,9%, e secundárias, 5,1%. No entanto, houve diminuição progressiva do coeficiente desses procedimentos a cada ano. CONCLUSÕES: Este trabalho permite inferir que a incidência de amputação de membros inferiores foi maior no sexo masculino e teve como principal causa a doença aterosclerótica, mas apresentou uma redução progressiva.
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Costa-Val R, Campos-Christo SF, Abrantes WL, Campos-Christo MB, Marques MC, Miguel EV. Reflexões sobre o trauma cardiovascular civil a partir de um estudo prospectivo de 1000 casos atendidos em um centro de trauma de nível I: a prospective study from 1000 cases. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000300005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar os dados referentes a uma grande série de casos de traumas cardiovasculares exclusivamente civil operados em um único centro de trauma brasileiro. MÉTODO: Trata-se de um estudo de coorte, prospectivo, descritivo e analítico registrados entre os anos de 1998 - 2005. RESULTADOS: No período foram operados 1000 casos que acometeram principalmente homens jovens devido a armas de fogo, armas brancas/vidros e trauma contuso e cuja topografia das lesões se deu na seguinte ordem: abdominais, cervicais, torácicas e extremidades. As três síndromes mais comuns a admissão foram: hemorrágica, isquêmica e hemorrágica/isquêmica. No entanto, 34.6% dos pacientes estavam em choque hipovolêmico grave e em 85% da casuística havia lesões não cardiovasculares associadas. A maioria dos pacientes foi submetida a tratamento cirúrgico sem propedêutica específica, mas 14% destes foram reoperados devido à síndrome compartimental, trombose aguda e/ou hemorragia grave. A taxa de amputação foi de 5.5% e da mortalidade de 7.5%, estando correlacionada com choque hipovolêmico grave ou síndrome da resposta inflamatória sistêmica. Lesões CCV isoladas ocorreram em 15% dos casos com taxa de letalidade global de 41%, sendo 22% venosa, 47% arterial e 81% cardíaca, proporcionando diferença significativa entre lesões cardíacas versus arteriais e venosas associadas (p = 0,01; odds ratio de 7.37) e lesões arteriais versus venosas (p = 0,01; odds ratio de 3.17). CONCLUSÃO: Esta grande série de casos demonstrou ser o homem jovem o mais acometido devido principalmente à violência interpessoal e os acidentes automobilísticos, que envolvem na maioria das vezes as extremidades, associadas com lesões em outros órgãos ou sistemas. Os fatores preditivos de mau prognóstico foram choque hipovolêmico, lesão de grandes vasos arteriais e lesão cardíaca.
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Affiliation(s)
- Ricardo Costa-Val
- Sociedade Brasileira de Angiologia e Cirurgia Vascular; Universidade Federal de Minas Gerais
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