ABSTRACT
Brachial artery aneurysms are relatively rare and are mostly pseudoaneurysms rather than true aneurysms, as true aneurysms are even rarer entities. Patients can be asymptomatic, or present with pulsatile masses, or ischemia due to associated thromboembolic complica-tions. Distal embolism can occur with transient or minimal ischemic symptoms; however, aneurysm itself can thrombose entirely. The authors report a case of upper limb acute ischemia caused by true brachial artery aneurysm thrombosis in an elderly man, managed by reconstructive vascular surgery.
ABSTRACT
The purpose of this study is to report management techniques and factors associated with early limb salvage following high risk popliteal vascular injury. Additionally controversial aspects of popliteal vascular injury management unique to an Iranian trauma center are discussed. A retrospective analysis was conducted of prospectively collected data Ji.om Tabriz Medical Trauma Center. Patients were divided into two study groups: Group 1 Limb salvage and Group 2 Amputation. Subgroup analysis consisted of university analysis comparing the Group land Group 2 as well as multivariate analysis examining factors associated negatively and positively with the primary endpoint, limb salvage. Sixty of the patients [97%] were male, two female [3%]; the mean age was 34.years [16-49 years].The overall amputation rate in the present study was 23 amputations [37%].On logistic regression analysis, significant [P<0.05] independent factors associated negatively with limb salvage were combined tibia and fibula fracture [OR 0.133; CI 0.01 7 -1.01 8], concomitant artery and vein injury [OR 0.039; CI 0.004- 0.407], ligation of venous injury [OR 0.326; CI 0.161 - 0.660], lack of back flow after Fugarty catheter thrombectomy [OR 0.129; CI 0.023-0.729], while repair of popliteal artery and vein injury [OR 2.81; CI 2.22 -6.53] when present was associated with improved early limb salvage. Expeditious recognition of vascular injury, transport to repair and repair of associated venous injury when possible are necessary to optimize limb salvage. A low threshold for timely amputation when limb salvage is not possible is important to prevent life-threatening complications
ABSTRACT
Infected femoral artery pseudo aneurysm [IFAP] is a severe complication in parenteral drug abusers, with difficult and controversial management. Seventeen consecutive patients were admitted to our department with IFAP due to intravenous drug abuse. In all 17 patients proximal and distal ligation of common femoral artery mas performed with drainage of the abscess and excision of the pseudo aneurysm without reconstruction. The lower limb mas monitored for symptom of acute ischemia including coldness, sensory and motor impairment, as well as changes in color and capillary refilling. In all 17 patients, the affected artery was 1igated.Ligation of the common femoral or superficial femoral artery alone was performed in 13 and 4 of the cases, respectively In eight cases the pseudo aneurysm involved the distal, in six the mid, and in three the inferior border of the inguinal ligament. We did not have bifurcation involvement and need for triple ligation [common, superficial and profunda femoral artery], Patients were closely observed during and following surgery and this led to revascularization in tow patients who demonstrated symptom of acute ischemia. In one of them bypass surgery was performed 24 hours after surgery and led to amputation due to filed revascularization, and the other patient mas required revascularization 2 months after ligation of common and moral artery because of severe intermittent claudication of affected limb. In the setting of complex infected femoral pseudo aneurysms in patients prone to substance abuse, our work demonstrates that ligation and excision of IFAP without reconstruction may be the preferred option