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Vascular Surgery 2019
Journal of Vascular and Endovascular Therapy
ISSN: 2573-4482
Page 71
March 28-29, 2019
Rome, Italy
Vascular Surgery
4
th
Edition of World Congress & Exhibition on
J Vasc Endovasc Therapy 2019, Volume 4
DOI: 10.21767/2573-4482-C1-006
A challenging surgery for limb salvage after brachial artery injury
Ayman Khalil
AMC Hospital, Egypt
Statement of the Problem:
The brachial artery is themost
frequently injured artery in the upper extremity (28% of all
vascular injuries). There is a high incidence of associated
nerve injuries with the brachial artery injuries, accounting
for 27% to 44% rate of functional disability after operative
procedure. Beyond a golden period of 6 to 8 hours of
ischemia, ischemia-reperfusion injury will endanger
the viability of the limb. It has been documented that
the primary end-to-end anastomosis is superior to the
saphenous vein interposition graft, and the later in turn is
more preferable than repair with synthetic graft.
Methodology:
A 22-year-old male patient was admitted
to our department with glass-lacerated wound at his
left elbow with signs of brachial artery injury in the
form of brisk bleeding, cold and cyanosed upper limb,
absent radial and ulnar pulses and associated profound
neurological deficits. The patient was significantly
having severe rest pain, indicating severe arterial injury
and presented to us more than 6 hours after the injury.
An average brachial- brachial Doppler index <0.5 was
considered diagnostic for brachial artery injury. After
patient resuscitation, exposure of the brachial artery at
the elbow was done, primary end-to-end anastomosis
was performed with difficulty due to >3 cm gap, then
repair of the associated nerve injuries (median and radial
nerves).
Findings:
The patient had good arterial blood flow
postoperatively assessed by clinical examination and
duplex ultrasonography, and he was followed 1 month
after the operation then every 3-month period. He had
residual functional disability due to the associated nerve
injuries in the form of wrist and finger drop.
Conclusion:
Limb salvage can be done even in cases
of severe brachial artery injuries that may be repaired
even beyond the golden time, but the residual functional
disability due to associated nerve injuries may
significantly affect the outcome
draymankhalil55@gmail.com