Conservative Approach is Safe for Perfused-Pulseless Hands Following Blunt Brachial Artery Injury in Children

Blunt trauma of the brachial artery (BA) in pediatric age is often associated with neurological and orthopaedic injuries. Acute ischemic hands warrant immediate exploration, but the management of warm-pulseless hands following elbow trauma is controversial. This study evaluates the role of conservative treatment of blunt BA injuries in children with non-threatened hands. Eleven children with blunt trauma onto the BA having warm-pulseless hands were studied retrospectively. After a mean follow-up period of 2.5 ± 0.9 years, all cases had thorough clinical examination and duplex scan to assess the treatment outcomes. At the end of follow-up period, all subjects had well-perfused hands with intact wrist pulses. The duplex scan revealed those who had interposition grafts to be patent and one case had an aneurysmal dilatation. There was no statistical significance difference between affected and healthy forearms regarding the mean peak systolic velocity at the wrist, affected side was 62 ± 0.82 cm/s versus 68 ± 0.57 cm/s for opposite side ( p -value = 0.14). Patients with blunt BA trauma and warm-pulseless hands could be managed safely with conservative treatment, leaving surgical exploration for those who did not regain pulses after 48 hours. Duplex ultrasound can safely verify the patency of surgical repair and can be used for surveillance to detect future complications.

One-year results of stent graft repair for carotid artery pseudo-aneurysm in patients with Behcet's disease

OBJECTIVES

Behcet's disease is a multisystem disorder of unknown etiology with vascular complications. This study reviewed the mid-term outcome of Behcet's disease patients with carotid artery pseudo-aneurysms treated by endovascular stent-graft repair at our unit.

METHODS

During a period of 11 years, six cases were included. Postoperative ultrasound duplex results were recorded along with computed tomography angiography report done a year after intervention.

RESULTS

The mean age (±SD) was 38 (±5.2) years. The mean (±SD) pseudo-aneurysm size was 33 (±12.2) mm. Technical success was 83%; failed cannulation of the internal carotid artery was encountered in one case. On day 2 post-operative, a duplex ultrasound revealed complete exclusion and thrombosis of the false aneurysm in all cases. A year later, a computed tomography angiography revealed a primary patency rate of 80%, and only one case had a recurrent pseudo-aneurysm at the distal margin of the stent graft. All cases, however, had complete thrombosis in the pseudo-aneurysms lumen with a mean (±SD) regression in size of 18 (±6) mm. The mean (±SD) percentage of in-stent stenosis was 34.5% (±11.73%).

CONCLUSIONS

Stent graft repair for carotid artery pseudo-aneurysm in Behcet's disease patients might be the preferable first line of treatment since it had a high technical success and mid-term primary patency rates, with additional fact that it obviously avoids the hazardous complications of surgery.