1
|
Grzeda AL, Hicks AC, Cheadle GA, Sangroula D, Wayne EJ, Dwivedi AJ, Sigdel A. Endovascular Repair of Transected Axillary Artery via Snare Assisted Through and Through Femoral to Brachial Artery Access. Am Surg 2022; 88:1543-1545. [PMID: 35337191 DOI: 10.1177/00031348221083936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Axillary artery injury is a rare but complex surgical problem that often requires challenging exposures, lengthy operations, and morbid outcomes for repair. For these reasons, endovascular repair is an attractive alternative as it obviates many of the challenges present with open repair. While pseudoaneurysms, dissections, and short segment injuries with limited arterial disruption are regularly treated endovascularly, complete arterial transections are almost exclusively treated with open repair as obtaining wire access across the site of injury is often not possible. Here we report a case of successful endovascular repair of a completely transected axillary artery with the use of snare assistance to obtain through and through femoral to brachial artery access. This ultimately allowed for covered stent deployment across the axillary transection restoring distal blood flow. Snare assistance in obtaining through and through access across areas of complete transection can allow for increased use of endovascular repair.
Collapse
Affiliation(s)
- Anthony L Grzeda
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Adam C Hicks
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Gerald A Cheadle
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Daisy Sangroula
- Department of Anesthesiology, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Erik J Wayne
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Amit J Dwivedi
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - Abindra Sigdel
- Department of Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| |
Collapse
|
2
|
Miles O, Perotti O, Wang JY, Anavekar N. Posterior arm flap for axillary coverage in the setting of bifid axillary vein resection. ANZ J Surg 2021; 92:877-879. [PMID: 34396661 DOI: 10.1111/ans.17146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Oliver Miles
- Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Olivia Perotti
- Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Ji Yue Wang
- Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Namrata Anavekar
- Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
| |
Collapse
|
3
|
Stone MA, Ihn HE, Gipsman AM, Iglesias B, Minneti M, Noorzad AS, Omid R. Surgical anatomy of the axillary artery: clinical implications for open shoulder surgery. J Shoulder Elbow Surg 2021; 30:1266-1272. [PMID: 33069906 DOI: 10.1016/j.jse.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/08/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Axillary artery injury is a devastating complication related to anterior shoulder surgery and can result in significant morbidity and/or mortality. The purpose of our study was to evaluate the course of the axillary artery in relation to bony landmarks of the shoulder and identify variations in artery position with humeral external rotation. MATERIALS AND METHODS Dissection of 18 shoulders (9 fresh whole-body cadavers) with simulated vessel perfusion using radiopaque dye was performed. The axillary artery position was measured from multiple points including 2 points on the coracoid base (C1 and C2), 3 points on the coracoid tip (C3-C5), 4 points on the glenoid: superior, middle, and inferior glenoid (D1-D4), and 2 points on the lesser tuberosity (L1 and L2). Fluoroscopic measurements were taken and compared at 0° and 90° of external rotation (F1 vs. F1' and F2 vs. F2'). Manual and fluoroscopic measurements were compared with one another using Kendall's τb correlation. RESULTS There were 6 male and 3 female cadavers with an average age of 67.2 ± 9.3 years (range: 49-77 years). The mean distance from the axillary artery to the coracoid base (C1 and C2) measured 21.1 ± 7.3 and 22.3 ± 7.4 mm, respectively, whereas the mean distance to the coracoid tip (C3, C4, and C5) measured 30.7 ± 9.3, 52.1 ± 20.2, and 46.5 ± 14.3 mm, respectively. Measurements relative to the glenoid face (D1, D2, and D3) showed a progressive decrease in mean distance from superior to inferior, measuring 31.6 ± 10.3, 16.5 ± 7.5, and 10.3 ± 7.3 mm, respectively, whereas D4 (inferior glenoid to axillary artery) measured 17.8 ± 10.7 mm. The minimum distance from the axillary artery to any point on the glenoid was as close as 4.1 mm (D3). There was a statistically significant difference in F1 (0° external rotation) vs. F1' (90° external rotation) (18.5 vs. 13.4 mm, P = .03). Kendall's τb correlation showed a strong, positive correlation between manual and fluoroscopic measurements (D4: 16.0 ± 12.5 mm vs. F1: 18.5 ± 10.7 mm) (τb = 0.556, P = .037). CONCLUSION The axillary artery travels an average of 1-1.8 cm from the inferior glenoid margin, which puts the artery at significant risk. In addition, the artery is significantly closer to the inferior glenoid with humeral external rotation. Surgeons performing anterior shoulder surgery should have a thorough understanding of the axillary artery course and understand changes in the position of the artery with external rotation of the humerus.
Collapse
Affiliation(s)
- Michael A Stone
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Hansel E Ihn
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aaron M Gipsman
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brenda Iglesias
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Minneti
- Fresh Tissue Dissection Program, University of Southern California Surgical Skills Simulation & Education Center, Los Angeles, CA, USA
| | - Ali S Noorzad
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Reza Omid
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
4
|
Shaikh S, Boneva D, Hai S, McKenney M, Elkbuli A. Ballistic Axillary Vein Transection: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1869-1873. [PMID: 31836697 PMCID: PMC6930707 DOI: 10.12659/ajcr.919090] [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] [Indexed: 11/21/2022]
Abstract
Patient: Male, 25-year-old Final Diagnosis: Axillary vein transection Symptoms: Shortness of breath Medication: — Clinical Procedure: Ligation of the axillary vein Specialty: Surgery
Collapse
Affiliation(s)
- Saamia Shaikh
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Shaikh Hai
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| |
Collapse
|
5
|
Angus LDG, Gerber N, Munnangi S, Wallace R, Singh S, Digiacomo J. Management and Outcomes of Isolated Axillary Artery Injury: A Five-Year National Trauma Data Bank Analysis. Ann Vasc Surg 2019; 65:113-123. [PMID: 31678544 DOI: 10.1016/j.avsg.2019.10.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/20/2019] [Accepted: 10/19/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study is to evaluate recent national trends in the clinical characteristics, management, and outcomes of patients with isolated axillary artery injuries. METHODS The National Trauma Data Bank was queried to identify records submitted from 2011 to 2015 that contained an ICD-9-CM diagnosis code for an injury to axillary artery (903.01) and an external cause of injury code indicating blunt or penetrating trauma. Records that contained a diagnosis code for an injury to an additional blood vessel (900.00-903.00, 903.2-904.9), an injury to a nonupper extremity or unclassifiable body region, or whose operative management could not be discerned were excluded. The final study sample included 221 patients with isolated axillary artery injury. The patient's clinical management was the primary outcome of interest. The study sample was stratified by trauma type, and descriptive statistics were performed on all variables. RESULTS Seventy-one percent of patients received operative management. Patients with penetrating injury were 24% more likely to be managed operatively than bluntly injured patients (76.9% vs. 62.1%, P = 0.0178). In operatively managed patients, the open repair rate was 82.8% and endovascular repair rate was 10.2%. Graft repair was performed most often (28.0%), followed by placement of a temporary intravenous shunt (17.8%) and surgical occlusion (10.2%). Surgical vessel occlusion was significantly more likely to be performed on patients with penetrating injury than with blunt injury (14.6% vs. 1.9%, P = 0.0124). Patients with penetrating injury had significantly shorter median emergency department length of stay (87.0 min vs. 152.0 min, P < 0.0001), intensive care unit length of stay (2.0 days vs. 3.0 days, P < 0.0388), hospital length of stay (4.0 days vs. 5.0 days, P = 0.0026), and time-to-operative management (1.6 hr vs. 3.9 hr, P < 0.001) compared to bluntly injured patients. Patients with blunt injury had a higher reportable in-hospital complication rate (13.8% vs. 6.0%, P = 0.0477). The overall mortality rate was 3.1% for isolated axillary artery injuries and did not significantly differ by trauma type. CONCLUSIONS Axillary artery injury is more often caused by penetrating trauma. Despite introduction of novel endovascular techniques, the majority of patients with isolated axillary artery injury are managed using open repair. Penetrating axillary artery injury is significantly more likely to be managed using open repair and by surgical occlusion. Patients with blunt injury have higher complication rates and longer hospital length of stays. The mortality rate is lower than previously published.
Collapse
Affiliation(s)
- L D George Angus
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Noam Gerber
- Department of Surgery, Nassau University Medical Center, East Meadow, NY.
| | - Swapna Munnangi
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Raina Wallace
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Shridevi Singh
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Jody Digiacomo
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| |
Collapse
|
6
|
Padegimas EM, Schoch BS, Kwon J, DiMuzio PJ, Williams GR, Namdari S. Evaluation and Management of Axillary Artery Injury: The Orthopaedic and Vascular Surgeon’s Perspective. JBJS Rev 2017. [DOI: 10.2106/jbjs.rvw.16.00082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|