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Archives of Orthopaedic and Trauma... 1990A case of elbow dislocation with injury to the brachial artery is described. The rarity of the complication makes the treatment controversial. Conservative treatment... (Review)
Review
A case of elbow dislocation with injury to the brachial artery is described. The rarity of the complication makes the treatment controversial. Conservative treatment should be the first line of management of this vascular complication.
Topics: Adult; Brachial Artery; Humans; Joint Dislocations; Male; Elbow Injuries
PubMed: 2271365
DOI: 10.1007/BF00419947 -
The Journal of Trauma Feb 1995A case report of a closed posterior elbow dislocation with brachial artery rupture treated with a reversed saphenous vein graft, fasciotomy, and medical collateral... (Review)
Review
A case report of a closed posterior elbow dislocation with brachial artery rupture treated with a reversed saphenous vein graft, fasciotomy, and medical collateral ligament (anterior oblique component) repair is presented. A literature review of 21 other similar cases is discussed. Three patients were treated with direct arterial suturing, four with ligation, four closed reductions, nine vein grafts, and two were undescribed. Early postoperative complications included anastomosis failure in two patients (9%) and thrombosis in three patients (14%). At final follow-up, 12 patients (55%) had a motor and/or sensory deficit, and 11 patients (50%) had restriction of elbow extension. Seven of these 11 patients had a loss of elbow extension of 5 to 15 degrees; the other four patients had a loss of 20 to 35 degrees.
Topics: Adult; Brachial Artery; Elbow Joint; Humans; Joint Dislocations; Male; Radiography; Elbow Injuries
PubMed: 7869460
DOI: 10.1097/00005373-199502000-00034 -
European Journal of Sport Science 2015Rock climbers perform repeated isometric forearm muscle contractions subjecting the vasculature to repeated ischaemia and distorted haemodynamic signals. This study...
Rock climbers perform repeated isometric forearm muscle contractions subjecting the vasculature to repeated ischaemia and distorted haemodynamic signals. This study investigated forearm vascular characteristics in rock climbers compared to healthy untrained controls. Eight climbers (CLIMB) (BMI; 22.3, s = 2.0 kg/m(2), isometric handgrip strength; 46, s = 8 kg) were compared against eight untrained controls (CON) (BMI; 23.8, s = 2.6 kg/m(2), isometric handgrip strength; 37, s = 9 kg). Brachial artery diameter and blood flow were measured, using Doppler ultrasound, at rest and following 5-mins ischaemia (peak diameter) and ischaemic exercise (maximal dilation) to calculate flow mediated dilation (FMD) and dilatory capacity (DC). Capillary filtration capacity was assessed using venous occlusion plethysmography. Resting (4.30, s = 0.26 vs. 3.79, s = 0.39 mm), peak (4.67, s = 0.31 vs. 4.12, s = 0.45 mm) and maximal (5.14, s = 0.42 vs. 4.35, s = 0.47 mm) diameters were greater (P < 0.05) in CLIMB than CON, respectively, despite no difference in FMD (9.2, s = 2.6 vs. 8.7, s = 2.9%). Peak reactive hyperaemic blood flow (1136, s = 504 vs. 651, s = 221 ml/min) and capillary filtration capacity (3.8, s = 0.9 vs. 5.2, s = 0.7 ml.min(-1).mmHg(-1).100 ml tissue(-1) × 10(-3)) were greater (P < 0.05) in CLIMB compared to CON, respectively. Rock climbers exhibit structural vascular adaptation compared to untrained control participants but have similar vascular function. This may contribute to the enhanced ability of climbers to perform repeated isometric contractions.
Topics: Adaptation, Physiological; Adult; Brachial Artery; Capillaries; Forearm; Hand Strength; Humans; Ischemia; Isometric Contraction; Male; Mountaineering; Muscle, Skeletal; Plethysmography; Regional Blood Flow; Ultrasonography; Vascular Remodeling; Young Adult
PubMed: 25068834
DOI: 10.1080/17461391.2014.940560 -
The Journal of Vascular Access Nov 2023We describe a technique to mature a basilic/brachial vein in the mid-arm in preparation for a second stage loop proximal brachial artery to basilic/brachial vein...
BACKGROUND
We describe a technique to mature a basilic/brachial vein in the mid-arm in preparation for a second stage loop proximal brachial artery to basilic/brachial vein arteriovenous graft (BBAVG). This can occur after a failed basilic/brachial vein transposition or a lack of adequate veins in the distal arm. This allows a mature vein to be used in an end-to-end configuration as an outflow to a BBAVG while preserving proximal vessels for the future.
METHODS
This single-center retrospective study was performed from 2015 to 2021, including 104 AVG patients divided into three groups: (1) Patients who failed a basilic vein transposition and had an enlarged vein suitable for an AVG outflow; (2) Patients who had a small caliber basilic/brachial vein after the transposition, requiring a mid-arm brachial artery to brachial/basilic arteriovenous fistula (AVF) creation with a subsequent AVG extension; (3) and lastly, patients who had no distal arm veins available and required a primary brachial artery to basilic/brachial AVF with AVG extension. A survival analysis was performed looking at time to loss of primary and secondary patency, calculated with Kaplan-Meier estimates and Cox regression models adjusted for covariates.
RESULTS
The median follow-up time was 11 months (IQ = 11-30 months). The survival analysis showed 28% lost primary patency at a median time of 9 months, and 14% lost secondary patency at a median time of 61 months. Overall secondary patency of the vascular access measured at 12 months was 85.6%. Loss of primary ( = 0.008) and secondary patency ( = 0.017), as well as patency during the first 12 months ( = 0.036), were all significantly associated with increased age when adjusting for covariates.
CONCLUSIONS
Our results suggest that the graft extension technique using a mature vein from a previous fistula can result in reliable and durable access. This is important for patients with limited access for hemodialysis, as the axillary vein is preserved for future use if needed.
Topics: Humans; Brachial Artery; Arteriovenous Shunt, Surgical; Retrospective Studies; Renal Dialysis; Vascular Patency; Treatment Outcome
PubMed: 35302422
DOI: 10.1177/11297298221080792 -
Journal of Vascular Surgery Oct 1986During a 3-year period, 12,158 cardiac catheterizations were performed via the brachial artery. During this same period, 106 patients were operated on for complications...
During a 3-year period, 12,158 cardiac catheterizations were performed via the brachial artery. During this same period, 106 patients were operated on for complications of brachial artery injury and/or thrombosis, an incidence of 0.9%. The indication for the cardiac catheterization was coronary artery disease in almost 92% of the patients. Early (less than 4 days) brachial artery repair was done in 90% of the patients. The operative findings were thrombosis (91%), intimal injury (54%), stenosis (13%), laceration and/or perforation (11%), and atherosclerotic plaque (6%). Because of vessel injury, localized resection was done in two thirds of the patients. Vascular continuity was obtained with axial reanastomosis in 45 patients and interposition vein graft in 26 patients. Primary lateral repair was performed in 23 patients (22%). Ninety-five percent (101 patients) had initial excellent results. Of the five patients who required reoperation, flow was restored in four patients. Thus, 99% of patients had restoration of a patent brachial artery. Contributing factors for brachial artery complications are "redo" catheterization, prolonged catheterization time, catheter change, brachial artery atherosclerosis, improper arteriotomy closure, experience of cardiologist, female patient, and failure to use heparin. Because of the unpredictability of ischemic symptoms occurring after brachial artery thrombosis, the need for bypass graft surgery when delayed, and the good results with early surgical intervention, early exploration of brachial artery complications after cardiac catheterization and appropriate repair are recommended.
Topics: Adult; Aged; Aged, 80 and over; Brachial Artery; Cardiac Catheterization; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Thrombosis
PubMed: 3761478
DOI: No ID Found -
Journal of Vascular Surgery Jun 2015This study validated duplex ultrasound measurement of brachial artery volume flow (VF) as predictor of dialysis access flow maturation and successful hemodialysis.
OBJECTIVE
This study validated duplex ultrasound measurement of brachial artery volume flow (VF) as predictor of dialysis access flow maturation and successful hemodialysis.
METHODS
Duplex ultrasound was used to image upper extremity dialysis access anatomy and estimate access VF within 1 to 2 weeks of the procedure. Correlation of brachial artery VF with dialysis access conduit VF was performed using a standardized duplex testing protocol in 75 patients. The hemodynamic data were used to develop brachial artery flow velocity criteria (peak systolic velocity and end-diastolic velocity) predictive of three VF categories: low (<600 mL/min), acceptable (600-800 mL/min), or high (>800 mL/min). Brachial artery VF was then measured in 148 patients after a primary (n = 86) or revised (n = 62) upper extremity dialysis access procedure, and the VF category correlated with access maturation or need for revision before hemodialysis usage. Access maturation was conferred when brachial artery VF was >600 mL/min and conduit imaging indicated successful cannulation based on anatomic criteria of conduit diameter >5 mm and skin depth <6 mm.
RESULTS
Measurements of VF from the brachial artery and access conduit demonstrated a high degree of correlation (R(2) = 0.805) for autogenous vein (n = 45; R(2) = 0.87) and bridge graft (n = 30; R(2) = 0.78) dialysis accesses. Access VF of >800 mL/min was predicted when the brachial artery lumen diameter was >4.5 mm, peak systolic velocity was >150 cm/s, and the diastolic-to-systolic velocity ratio was >0.4. Brachial artery velocity spectra indicating VF <800 mL/min was associated (P < .0001) with failure of access maturation. Revision was required in 15 of 21 (71%) accesses with a VF of <600 mL/min, 4 of 40 accesses (10%) with aVF of 600 to 800 mL/min, and 2 of 87 accesses (2.3%) with an initial VF of >800 mL/min. Duplex testing to estimate brachial artery VF and assess the conduit for ease of cannulation can be performed in 5 minutes during the initial postoperative vascular clinic evaluation.
CONCLUSIONS
Estimation of brachial artery VF using the duplex ultrasound, termed the "Fast, 5-min Dialysis Duplex Scan," facilitates patient evaluation after new or revised upper extremity dialysis access procedures. Brachial artery VF correlates with access VF measurements and has the advantage of being easier to perform and applicable for forearm and also arm dialysis access. When brachial artery velocity spectra criteria confirm a VF >800 mL/min, flow maturation and successful hemodialysis are predicted if anatomic criteria for conduit cannulation are also present.
Topics: Arteriovenous Shunt, Surgical; Blood Flow Velocity; Blood Vessel Prosthesis Implantation; Brachial Artery; Female; Humans; Male; Postoperative Complications; Predictive Value of Tests; Regional Blood Flow; Renal Dialysis; Reproducibility of Results; Retrospective Studies; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Upper Extremity
PubMed: 25769390
DOI: 10.1016/j.jvs.2015.01.036 -
The Journal of Cardiovascular Surgery Jun 2014
Review
Topics: Aneurysm; Arteriovenous Shunt, Surgical; Brachial Artery; Dilatation, Pathologic; Humans; Kidney Transplantation; Male; Middle Aged; Renal Dialysis; Renal Insufficiency, Chronic; Reoperation; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Grafting; Veins
PubMed: 24172601
DOI: No ID Found -
Anatomical Science International Jun 2011The human superficial brachial artery passes superficially to the median nerve and can be classified into three subtypes according to its topographical relationship to...
The human superficial brachial artery passes superficially to the median nerve and can be classified into three subtypes according to its topographical relationship to the pectoral ansa. When the superficial brachial artery passes superficially to the pectoral ansa, it is defined as the highest superficial artery. We found the highest superficial brachial arteries in both arms of a single cadaver. The right one coexisted with a normal axillary artery, and its identification was not difficult. The left one ran medially to the brachial plexus proximally and became superficial to the brachial plexus after branching off the artery, which gave the subscapular artery, then passed between the radial nerve and its accessory root from deep to superficial and ended as an inferior collateral ulnar artery. We also found a muscular axillary arch in each of the arms, both of which were innervated by the medialmost branch from the pectoral ansa. The right highest superficial brachial artery passed deep to the nerve to the muscular axillary arch. We conjectured that the left axillary artery is where the highest superficial brachial artery, as found on the right, coexists with the axillary artery in the case of Adachi's C-type brachial plexus (AxC). Then, the highest superficial brachial artery develops as a main stem, and the latter remains as a rudimentary AxC. Because the left axillary artery is caught on neither the pectoral ansa nor its branches, the left axillary artery can shift medially to the brachial plexus, and its true form is not obvious.
Topics: Axillary Artery; Brachial Artery; Humans; Upper Extremity
PubMed: 20963540
DOI: 10.1007/s12565-010-0094-2 -
European Heart Journal Mar 2021
Topics: Brachial Artery; Coronary Angiography; Coronary Vessel Anomalies; Humans; Internal Mammary-Coronary Artery Anastomosis; Mammary Arteries
PubMed: 33462623
DOI: 10.1093/eurheartj/ehab015 -
The Journal of Vascular Access 2014Peripheral artery aneurysms proximal to a long-standing arteriovenous (AV) fistula can be a serious complication. It is important to be aware of this and manage it...
PURPOSE
Peripheral artery aneurysms proximal to a long-standing arteriovenous (AV) fistula can be a serious complication. It is important to be aware of this and manage it appropriately.
METHODS
Vascular access nurses input all data regarding patients undergoing dialysis access procedures into a securely held database prospectively. This was retrospectively reviewed to identify cases of brachial artery aneurysms over the last 3 years.
RESULTS
In Morriston Hospital, around 200 forearm and arm AV fistulas are performed annually for vascular access in renal dialysis patients. Of these, approximately 15 (7.5%) are ligated. Three patients who had developed brachial artery aneurysms following AV fistula ligation were identified. All 3 patients had developed brachial artery aneurysms following ligation of a long-standing brachio-cephalic AV fistula. Two patients presented with pain and a pulsatile mass in the arm, and one presented with pins and needles and discoloration of fingertips. Two were managed with resection of the aneurysm and reconstruction with a reversed long saphenous vein interposition graft, the third simply required ligation of a feeding arterial branch.
CONCLUSIONS
True aneurysm formation proximal to an AV fistula that has been ligated is a rare complication. There are several reasons for why these aneurysms develop in such patients, the most plausible one being the increase in blood flow and resistance following ligation of the AV fistula. Of note, all the patients in this study were on immunosuppressive therapy following successful renal transplantation. Vigilance by the vascular access team and nephrologists is paramount to identify those patients who may warrant further evaluation and investigation by the vascular surgeon.
Topics: Adult; Aged; Aneurysm; Arteriovenous Shunt, Surgical; Brachial Artery; Female; Humans; Kidney Transplantation; Ligation; Male; Middle Aged; Renal Dialysis; Reoperation; Retrospective Studies; Risk Factors; Saphenous Vein; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Upper Extremity; Wales
PubMed: 24043327
DOI: 10.5301/jva.5000156