Axillary artery lesions from humeral neck fracture: A study in relation to repair

Axillary Artery Injuries Associated With Proximal Humerus Fractures: A Literature Review and a Proposal of a Novel Multidisciplinary Surgical Approach

INTRODUCTION

Proximal humerus fractures (PHF) are common injuries that can lead to axillary artery injury, which carries the risk of not being identified during initial assessment. The aim of this study was to describe the management of suspected axillary artery injury associated with PHF according to our experience and to describe a new multidisciplinary surgical approach.

METHODS

This was a single-center retrospective study. A database was created for patients admitted for PHF to the emergency department of the Hospital of Cannes between October 2017 and October 2019. Patients admitted with PHF associated with suspected ipsilateral upper limb ischemia, and/or massive diaphysis displacement, and/or upper limb ipsilateral neurological deficits were included in this study.

RESULTS

In total, 301 patients diagnosed with PHF were admitted within these periods. Among these patients, 12 presented with suspected axillary artery lesions, of whom, 6 were included in the present study and treated according to our new approach. A description of these 6 cases, along with an extensive literature review is presented.

CONCLUSION

Based on our experience, the endovascular approach proposed for the management of axillary artery injury associated with proximal humerus fractures is effective, feasible and reproducible.

Bidirectional endovascular treatment for axillary artery injury secondary to proximal humerus fracture: a case report

Background

Axillary artery injury secondary to proximal humerus fracture is a rare but serious complication. The management of this injury has traditionally involved surgical treatment.

Case summary

A 66-year-old female with gait disturbance slipped and fell off her wheelchair at home. She presented to a local hospital with right shoulder pain and was subsequently urgently transferred to our hospital by helicopter because of suspicion of axillary artery injury. Computed tomography angiography revealed disruption of the right axillary artery. We decided to perform endovascular treatment instead of surgical treatment for axillary artery injury. However, since endovascular treatment via the right femoral artery was impossible, we performed bidirectional (right femoral and right brachial artery approaches) endovascular treatment. We expanded the occluded lesion using a 3.5 mm × 40 mm sized balloon and placed a 5.0 mm × 50 mm stent graft (Gore^® Viabahn^®) across the lesion. The final subclavian injection confirmed that distal flow to the brachial artery was preserved and that there was no leakage of contrast medium from the axillary artery.

Discussion

We performed endovascular treatment for axillary artery injury secondary to proximal humerus fracture. Although surgical repair is typically performed for this kind of injury, our experience suggests that endovascular treatment might be an option in patients with axillary artery injury.

Axillary artery and brachial plexus injury secondary to proximal humeral fractures: A report of 2 cases

INTRODUCTION

Axillary artery and brachial plexus injuries have been reported to be associated with proximal humeral fractures. In this report, we present two cases of axillary artery and brachial plexus injury secondary to proximal humeral fracture.

PRESENTATION OF CASES

Case 1: An 88-year-old woman with cognitive impairment slipped and fell at home. The diagnosis was left proximal humeral fracture. The second day, paralysis of left upper arm due to left axillary artery occlusion appeared. Axillary-brachial artery bypass surgery was performed. After that, a radial artery pulse was palpable. Ten months have passed since the operation, but the neurologic deficit has not been restored. Case 2: A 74-year-old woman fell from a ladder. She was diagnosed with a right proximal humeral fracture and right axillary artery occlusion. Emergency axillary-brachial bypass surgery and osteosynthesis were performed. After reestablishing the blood flow, there have been no signs of blood flow disorders but paralysis has remained.

DISCUSSION

In neither of the two cases, were obvious findings of brachial plexus injury detected during surgery. The delayed onset of motor palsy implied that an ischemic factor was implicated in case 1. The acute onset of motor palsy might have been caused by a mechanical factor such as the dislocated of humeral head in case 2.

CONCLUSION

Axillary artery and brachial plexus injury secondary to proximal humeral fracture is rare but it can develop severe sequels. By identifying the high-risk patients, diagnosis and management of this vascular and plexus injury might lead to improvement.

Proximal humerus fracture dislocation leading to axillary artery injury in an young adult: Case report of an unusual presentation

Proximal humerus fractures constitute five percent of all fracture cases. Though rare, severely comminuted proximal humerus fractures can cause injury to neurovascular structure. Majority of these injuries reported in literature were in elderly age group from low velocity injury owing to loss of elasticity of vessel wall. We report a case of proximal humerus fracture dislocation associated with axillary artery injury in a young male due to fall of heavy iron object. Timely exploration and removal of impinging bone fragment restored the blood supply. The purpose of this report is to heighten the clinical suspicion of the vascular injury in patients with proximal humerus fracture dislocations in all age groups.

Axillary Artery Injury Accompanying Humeral Neck Fracture

Injuries to the axillary artery from proximal humeral fractures are uncommon. There are only 66 such injuries reported across the world literature to date. We report an additional case of axillary artery injury. This case highlights the importance of maintaining a high index of suspicion to prevent diagnostic delay.