Innominate Artery Cannulation for Proximal Aortic Surgery

ABSTRACT Introduction: The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side-graft technique in proximal aortic pathologies. Methods: A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an average age of 56±13 years. The indications for surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%), and ascending aorta pseudoaneurysm in one patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). Three patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta with hemiarch replacement in 34 patients (48.5%). Results: The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and 164+56 minutes, respectively. Mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22°C and 30°C during surgery. Thirty-day mortality rate was 7.1% (five patients). One patient (1.4%) had stroke, one patient (1.4%) had temporary neurologic deficit, and eight patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury. Conclusion: Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides satisfactory neurologic outcomes for proximal aortic surgery.

Common arterial trunk for the branches of the third portion of the axillary artery: description of a case and its clinical application / Tronco arterial común para las ramas de la tercera porción de la arteria axilar: descripción de un caso y su aplicación clínica

SUMMARY: Variations of the axillary artery may have clinical implications capable of generating unexpected situations during surgical procedures of arterial reconstruction or vascular catheterization. The objective of this work was to report the finding of an anatomical variant of the axillary artery, which may have clinical and surgical implications. A descriptive study was conducted, in which a unilateral vascular variation found during a routine dissection in a right upper limb of a male cadaver was reported. From the second portion of the axillary artery originated a common arterial trunk that gave rise to the subscapular, anterior humeral circumflex, posterior humeral circumflex and deep brachial arteries. The third portion of the axillary artery did not emit branches. The common arterial trunk originated from the second portion, 62.64 mm from the beginning of the axillary artery. Its total length was 23.72 mm and its thickness was 6.1 mm. The caliber of the branches originating from the common arterial trunk was: subscapular artery 5.1 mm, anterior humeral circumflex of 1.66 mm, posterior humeral circumflex 3.18 mm and deep brachial 3.73 mm. The vascular variant detected altered the anatomical relationship of the axillary artery with the brachial plexus, generating a modification in the position of the fascicles and their terminal branches. Anatomical variations of the axillary artery are not infrequent, knowing them may be necessary during surgical procedures or anatomical dissections.

RESUMEN: Las variaciones de la arteria axilar pueden tener implicancias clínicas capaces de generar situaciones inesperadas durante procedimientos quirúrgicos de reconstrucción arterial o cateterismo vascular. El objetivo de este trabajo fue reportar el hallazgo de una variante anatómica de la arteria axilar, la cual puede tener implicancias clínicas y quirúrgicas. Se realizó un estudio de tipo descriptivo, en el cual se reportó una variación vascular unilateral encontrada durante una disección de rutina en un miembro superior derecho de un cadáver de sexo masculino. De la segunda porción de la arteria axilar se originó un tronco arterial común que daba origen a las arterias subescapular, circunfleja humeral anterior, circunfleja humeral posterior y braquial profunda. La tercera porción de la arteria axilar no emitía ramas. El tronco arterial común se originaba de la segunda porción, a 62,64 mm del inicio de la arteria axilar. Su longitud total era de 23,72 mm y su grosor de 6,1 mm. El calibre de las ramas originadas del tronco arterial común fue: arteria subescapular 5,1 mm, circunfleja humeral anterior de 1,66 mm, circunfleja humeral posterior 3,18 mm y braquial profunda 3,73 mm. La variante vascular detectada alteraba las relaciones anatómicas de la arteria axilar con el plexo braquial, generando una modificación en la posición de los fascículos y sus ramos terminales. Las variaciones anatómicas de la arteria axilar son frecuentes, conocerlas puede ser necesario durante procedimientos quirúrgicos o disecciones anatómicas.

Herida por arma de fuego con lesión pulmonar, del plexo braquial, arteria axilar e intercostal

RESUMEN Introducción: Los traumas de tórax con lesiones vasculares asociadas, empeoran el pronóstico de los pacientes debido a la hemorragia. El 80 % de todos los traumas vasculares afectan las extremidades y el 30 % se localizan en los miembros superiores. Poder utilizar los propios tejidos del paciente para su reparación, es una alternativa de tratamiento viable, y en ocasiones la única posible. Objetivo: Presentar un paciente con trauma de tórax, con lesiones vasculares, en quien se utilizó la vena safena para restaurar el daño en la arteria axilar y la técnica de tractotomía, por hemotórax masivo con lesión del parénquima pulmonar. Caso clínico: Paciente masculino de 32 años, con herida causada por arma de fuego a nivel del hombro y hemitórax derecho, que ocasionó lesión de arteria axilar derecha y hemotórax masivo. Se realizó toracotomía con tractotomía a nivel del lóbulo superior derecho y ligadura de la arteria intercostal; y se exploró la región axilar derecha para reparar el daño vascular. Conclusiones: Para tratar el traumatismo torácico penetrante con lesión pulmonar sangrante, se debe realizar una tractotomía pulmonar y hemostasia, para evitar los hematomas intraparenquimatosos. Ante una lesión de arteria axilar irreparable, la vena safena es una alternativa viable para su restauración y lograr la vitalidad de la extremidad.

ABSTRACT Introduction: Chest traumas with associated vascular lesions worsen the prognosis of patients due to hemorrhage. 80 % of all vascular traumas affect the extremities and 30 % are located in the upper limbs. Being able to use the patient's own tissues for repair is a viable treatment alternative, and sometimes the only possible one. Objective: To present a patient with chest trauma with vascular lesions, where the saphenous vein was used to restore the damage in the axillary artery and the tractotomy technique for massive hemothorax with lesion of the lung parenchyma. Clinical case: 32-year-old male patient with a gunshot wound to the shoulder and right hemithorax, which caused injury to the right axillary artery and massive hemothorax. A thoracotomy with tractotomy was performed at the level of the right upper lobe and ligation of the intercostal artery; and the right axillary region was explored to repair vascular damage. Conclusions: To treat penetrating chest trauma with bleeding lung injury, a pulmonary tractotomy and hemostasis should be performed to avoid intraparenchymal hematomas. Faced with an irreparable axillary artery injury, the saphenous vein is a viable alternative for its restoration and to achieve the vitality of the limb.

Damage control of peripheral vascular trauma - Don't be afraid of axillary or popliteal fosses / Control de daños del trauma vascular periférico - No le tema a la fosa axilar o poplítea

Abstract Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient's life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed post-operatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.

Resumen El trauma vascular periférico no es común en el contexto civil, pero representa una amenaza para la vida del paciente o de la extremidad. El control definitivo de la lesión vascular representa un desafío quirúrgico, especialmente en pacientes con inestabilidad hemodinámica. Este artículo describe la propuesta de manejo del trauma vascular periférico de acuerdo con los principios de la cirugía de control de daños. Se debe identificar los signos sugestivos de lesión vascular y realizar oportunamente maniobras temporales para el control del sangrado. Se debe elegir el abordaje quirúrgico dependiendo del área anatómica lesionada. Se proponen dos nuevas incisiones para acceder a la región axilar y poplítea. La prioridad es restablecer la perfusión de la extremidad mediante el reparo primario o técnicas de control de daños (shunt vascular o abordaje endovascular). Los pacientes sometidos a cirugías vasculares mayores deben ser manejados postoperatoriamente en la unidad de cuidados intensivos para corregir las alteraciones fisiológicas e identificar aquellos que desarrollen un síndrome compartimental. Todos los procedimientos vasculares permanentes o temporales deben contar con un reparo definitivo en las primeras 8 horas. El diagnóstico temprano e intervención oportuna son fundamentales para salvaguardar la perfusión y funcionalidad de la extremidad.

Damage control of peripheral vascular trauma - Don't be afraid of axillary or popliteal fosses / Control de daños del trauma vascular periférico - No le tema a la fosa axilar o poplítea

Abstract Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient's life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed post-operatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.

Resumen El trauma vascular periférico no es común en el contexto civil, pero representa una amenaza para la vida del paciente o de la extremidad. El control definitivo de la lesión vascular representa un desafío quirúrgico, especialmente en pacientes con inestabilidad hemodinámica. Este artículo describe la propuesta de manejo del trauma vascular periférico de acuerdo con los principios de la cirugía de control de daños. Se debe identificar los signos sugestivos de lesión vascular y realizar oportunamente maniobras temporales para el control del sangrado. Se debe elegir el abordaje quirúrgico dependiendo del área anatómica lesionada. Se proponen dos nuevas incisiones para acceder a la región axilar y poplítea. La prioridad es restablecer la perfusión de la extremidad mediante el reparo primario o técnicas de control de daños (shunt vascular o abordaje endovascular). Los pacientes sometidos a cirugías vasculares mayores deben ser manejados postoperatoriamente en la unidad de cuidados intensivos para corregir las alteraciones fisiológicas e identificar aquellos que desarrollen un síndrome compartimental. Todos los procedimientos vasculares permanentes o temporales deben contar con un reparo definitivo en las primeras 8 horas. El diagnóstico temprano e intervención oportuna son fundamentales para salvaguardar la perfusión y funcionalidad de la extremidad.

The role of the axillary artery as a second access choice in TAVI procedures

Abstract With transcatheter aortic valve implantation (TAVI) technology expanding its indications for low-risk patients, the number of TAVI-eligible patients will globally grow, requiring a better understanding about the second-best access choice. Regarding the potential access sites, the transfemoral retrograde route is recognized as the standard approach and first choice according to current guidelines. However, this approach is not suitable in up to 10-15% of patients, for whom an alternative non-femoral access is required. Among the alternative non-femoral routes, the transaxillary approach has received increasing recognition due to its proximity and relatively straight course from the axillary artery to the aortic annulus, which provides a more accurate device deployment. Here we discuss some particular aspects of the transaxillary access, either percutaneously performed or by cutdown dissection.

Upper limb arterial pattern: clinical correlation and embryological perspective / Padrão arterial dos membros superiores: correlação clínica com perspectiva embriológica

Abstract Background Variations in the upper limb arterial pattern are commonplace and necessitate complete familiarity for successful surgical and interventional procedures. Variance in the vascular tree may involve any part of the axis artery of the upper limb, including the axillary artery and brachial artery or its branches, in the form of radial and ulnar arteries, which eventually supply the hand via anastomosing arches. Objectives To study the peculiarities of the arterial pattern of the upper limb and to correlate them with embryological development. Methods The entire arterial branching of forty-two upper limbs of formalin fixed adult human cadavers was examined during routine dissection for educational purposes, conducted over a 3-year period in the Department of Anatomy, Lady Hardinge Medical College, New Delhi. Results The study found: 1) One case in which a common trunk arose from the third part of the axillary artery, which immediately splayed into four branches (2.4%); 2) High division of the brachial artery into ulnar and radial arteries, in 3 cases (7.1%); 3) Pentafurcation of the brachial artery into ulnar, interosseus, radial, and radial recurrent arteries and a muscular twig to the brachioradialis in 1/42 cases (2.4%); 4) Incomplete Superficial Palmar arch in 3/42 cases (7.1%); and 5) Presence of a median artery in 2/42 case(4.8%) Conclusions This study observed and described the varied arterial patterns of the upper limb and identified the various anomalous patterns, supplementing the surgeon's armamentarium in various surgical procedures, thereby helping to prevent complications or failures of reconstructive surgeries, bypass angiography, and many similar procedures.

Resumo Contexto As variações no padrão arterial dos membros superiores são comuns e, assim, necessitam de total familiaridade para que os procedimentos cirúrgicos e de intervenção sejam bem-sucedidos. A variância na árvore vascular pode envolver qualquer parte da artéria axial dos membros superiores, incluindo a artéria axilar, a artéria braquial ou os seus ramos, na forma das artérias radial e ulnar, as quais, em algum momento, suprem as mãos através dos arcos anastomosados. Objetivos Avaliar as peculiaridades do padrão arterial dos membros superiores e correlacioná-las ao desenvolvimento embriológico. Métodos Foram examinados os ramos arteriais completos de 42 membros superiores de cadáveres adultos conservados em formalina, os quais eram rotineiramente dissecados para fins educacionais durante 3 anos no Departamento de Anatomia Lady Hardinge Medical College, Nova Delhi. Resultados O estudo apresentou cinco desfechos. 1. Foi constatado um caso em que um tronco comum surgiu da terceira parte da artéria axilar que imediatamente se disseminou em quatro ramos (2,4%). 2. Houve divisão maior da artéria braquial em artérias ulnar e radial em três casos (7,1%). 3. Em um caso, ocorreu pentafurcação da artéria braquial em ulnar, interóssea, radial, radial recorrente e de um galho muscular em braquiorradial (2,4%). 4. Foi constatado arco palmar superficial incompleto em três dos 42 casos (7,1%). 5. Foi observada a presença da artéria mediana em 2 dos 42 casos (4,8%). Conclusões Este estudo compreende o padrão arterial do membro superior e identifica os diversos padrões anômalos para agregar ao arsenal terapêutico de cirurgiões para diversos procedimentos cirúrgicos, com o objetivo de combater quaisquer complicações ou falhas de cirurgias reconstrutivas, de angiografias de cirurgias de revascularização e muitas outras.

Scapulothoracic dissociation and blunt vertebral vascular injury: case report / > Disociación escapulo-torácica y trauma cerrado de arteria vertebral: reporte de un caso

Abstract Case Description: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. Clinical Findings: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. Treatment and outcome: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae Clinical Relevance: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient's improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

Resumen Descripción del caso: Varón de 24 años que sufre accidente automovilístico con trauma penetrante de cuello y trauma cerrado cervico torácico izquierdo concomitante. Hallazgos clínicos: Shock hipovolémico, trauma en zona I cuello izquierdo, isquemia por trauma cerrado de vasos axilares y lesión por trauma cerrado del plexo braquial; producto de trauma de alto impacto. Sección de arteria vertebral por angiotomografia. Se diagnostica disociación escapulo-torácica y trauma de arteria vertebral. Tratamiento y resultado: Reconstrucción vascular arterio-venosa axilar, fasciotomías y abordaje no operatorio del trauma de arteria vertebral, con manejo diferido del trauma del plexo braquial. Sobrevida del paciente y su extremidad, con secuelas neurológicas mayores. Relevancia clínica: Es un caso de disociación escapulotorácica y lesión de arteria vertebral concomitante, siendo esta una asociación infrecuente y de alta morbi-mortalidad. El reconocimiento temprano de las lesiones y un abordaje multidisciplinario de este escenario de complejidad por medio de juntas quirúrgicas en varios niveles del proceso de atención, fueron determinantes para cambiar el pronóstico del paciente. Se presenta un análisis del diagnóstico, manejo y evolución; considerando el proceso de atención hospitalaria, toma consensuada de decisiones y el pronóstico en un paciente politraumatizado.

A rare variation of suprascapular artery originated from the axillary artery / Una rara variación de la arteria supraescapular originada de la arteria axilar

SUMMARY: The suprascapular artery (SSA) has been identified to be of clinical relevance to clavicular fracture, suprascapular neuropathy and surgical intervention of shoulder. Thus its origin and course have been intensively studied. In this case, we found a unilateral variation of the suprascapular artery, originating from the 1st segment of axillary artery, and sequentially penetrating the upper trunk of brachial plexus, passing through the suprascapular notch under the superior transverse scapular ligament. This case will be helpful to clinical management in cervical and shoulder region.

RESUMEN: Se ha identificado que la arteria supraescapular (ASS) tiene relevancia clínica en la fractura clavicular, la neuropatía supraescapular y la intervención quirúrgica del hombro. En consecuencia, su origen y su curso han sido ampliamente estudiados. En este caso, encontramos una variación unilateral de la arteria supraescapular, originada en el primer segmento de la arteria axilar, y que penetraba secuencialmente en el tronco superior del plexo braquial, pasando a través de la incisura supraescapular debajo del ligamento escapular transverso superior. Este caso será útil para el manejo clínico en la región cervical y del hombro.

An Anatomical Study Of Variations In The Branching Pattern Of Axillary Artery And Its Clinical Significance

Introduction: Variation in the branching pattern of axillary artery is quite common. Accurate knowledge of thenormal and variant arterial anatomy of the axillary artery is important for clinical procedures in axillary andpectoral region. The aim of this study is to find out the incidence and types of variation in the branching patternof axillary artery.Materials and Methods: Dissection of axillary and pectoral region was done on both sides in 25 cadavers in thedepartment of Anatomy, K.P.C. Medical College and Hospital, Kolkata to study the branching pattern of axillaryartery.Results: Variation was present in 16% cases. Among these, 6% variation was present in the second part and 10%variation was present in the third part of axillary artery. Most common variation found was the origin ofsubscapular artery from the second part of axillary artery.Conclusion: Proper knowledge of variations of branching pattern of axillary artery is important for orthopaedic,reconstructive and vascular surgeons to avoid complications during various surgical procedures in axillaryregions and angiographies.

Arterial And Neural Variations In The Right Upper Limb: A Case Report

Background: Variations of the arteries, nerves and muscles of the upper limb have both clinical and surgicalimportance. The superficial brachial artery origination from the third part of the axillary artery, communicationsbetween the musculocutaneous and median nerves, variant formation of the brachial plexus, origination of theProfunda brachii artery from the posterior circumflex humeral artery have been well documented. We describehere the other variations in the upper limbs of a male cadaver.Case Report: During our routine dissection studies on a 50year old male cadaver we encountered variations inRight upper limb.Observations: In this case we observed the axillary artery gives two terminal branches the first was the superficialbrachial artery and the second was a common trunk for the sub scapular,brachial, posterior circumflex humeral and anterior circumflex humeral arteries. Superficial brachial arterygive Radial and Ulnar arteries. Variant formations of the brachial plexus i.e., medial root of median nerveoriginate from both lateral and medial cord.Conclusion: We think that such variations should be kept in mind during surgical and diagnostic procedures.Variation in the brachial plexus medial root of median nerve originate from both lateral and medial cord mightbe of significance in diagnostic clinical neurophysiology.

Innominate vs. axillary artery cannulation in aortic surgery: a systematic review and meta-analysis

Abstract Objective: To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. Methods: A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017. Results: Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups. Conclusion: There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site.

Endovascular repair of a penetrating axillary artery injury

Abstract We report a 16-year-old boy who sustained a gunshot injury on his upper left side of the chest that resulted in an injury to the left axillary artery and was treated with endovascular repair. An endovascular repair has been increasingly accepted for the management of hemorrhage in critically ill trauma patients; using covered endovascular stents provides an alternative modality for both controlling hemorrhage and preserving flow.

Thoraco-Acromial Artery : A Cadaveric Study Of Its Pedicle And Branches

Background of study- A detailed knowledge of variations in the origin and branching pattern of Thoraco-acromial artery(TAA) is important during various reconstructive and microvascular surgeries. Materials and methods- Hundred formalin xed specimens were studied at Government Medical College, Kozhikode, Kerala, India over a period of four years. Results- Normal quadrifurcation pattern was observed in majority of specimens (84%). The division of TAA into two trunks was seen in 9% followed by ramication into multiple branches in 4% specimens. Some specimens showed trifurcation (3%). Conclusion- In this scenario of increasing reconstructive surgeries, a thorough knowledge on the anatomical variations of TAA will be helpful to surgeons as this artery provides vascular supply to Pectoralis Major Myo-Cutaneous ap.

Axillary Artery Injury with Intact Radial Pulse following Fracture-Dislocation of Shoulder: A Case Report

@#The occurrence of axillary artery injury following proximal humerus fracture dislocation in elderly patient with low velocity fall is uncommon. The patient could have diverse clinical presentations in spite of intact peripheral pulses. We report the case of an 85-year-old lady who presented to our emergency department with greater tuberosity fracture of the humerus with dislocation of the right shoulder. After closed manipulative reduction of the dislocation, it was observed that the patient had brachial plexus palsy with intact radial pulse. An expanding swelling and bruise around the shoulder was noted and a steady drop in haemoglobin level. CT angiogram revealed avulsion of the posterior circumflex artery which was then treated successfully with stenting.

A Study Of Anatomical Variation In Branching Pattern Of Axillary Artery

Background: The axillary artery is a direct continuation of the subclavian artery. The axillary artery is usuallygives off six branches. Variation in the branching pattern of axillary artery is very commonly seen. The knowledgein variations of axillary artery is helpful in anatomy, radiology and surgery to explain unexpected clinical signsand symptoms.Materials and Methods: The present study undertaken on 30 upper limb (15 cadevers) in department of Anatomyat RKDFMCH&RC, Jatkhedi, Bhopal. None of them had any pathological lesions, traumatic lesions or surgicalprocedures in the axillary region. Bilateral dissection of axilla was conducted and the branching patterns of theaxillary artery was studied.Observations and Results: Unilateral variations were observed in two cadavers. In (6.66%) cases we observed aunique variation of early division of axillary artey. In (3.33%) cases the second part of axillary artery showsthree extra branches (alar artery) In (3.33%) we observed a subscapular artery arises from the second part ofaxillary artery. Up to 36% of it arises from a common trunk with posterior circumflex humeral artery. In (3.33 %),bilaterally a common trunk from II part gave origin to anterior circumflex humeral, post circumflex humeral andsubscapular artery. In 3.33% cases the circumflex scapular artery directly arises from the third part of axillaryartery. In 6.66% cases the anterior circumflex is three in number.In the rest of the cadavers, axillary artery wasnormal in its course and distribution.Conclusion: The detailed knowledge about anatomy of normal as well as variant axillary artery is very helpful forthe surgeons and radiologists performing interventional surgery

Reparación de sección de arteria axilar por trauma vascular secundario a herida por arma blanca: a propósito de un caso / Repair of axillary artery section due to vascular trauma secondary to stab wounds: a case report

Objetivo: Presentar un caso clínico y discutir el manejo del trauma de arteria axilar y revisar la literatura actual. Caso Clínico: se presenta el caso de un paciente con lesión de arteria axilar, que es traído en shock hipovolémico al Servicio de Emergencias de nuestro hospital. En pabellón, se aprecia sección incompleta de la segunda porción de la arteria axilar. Se controla y repara con anastomosis primaria término-terminal. En su posoperatorio evoluciona de forma satisfactoria. Discusión: El manejo del trauma vascular debe ser metódico y multidisciplinario. Los signos duros de trauma vascular son indicación de exploración quirúrgica inmediata. Los pacientes con signos blandos pueden complementarse con imágenes. En una sección incompleta de arteria axilar, la anastomosis término-terminal ha mostrado buenos resultados. Conclusiones: las lesiones de arteria axilar en el contexto de traumas son infrecuentes. Su manejo necesita de un alto índice de sospecha, un enfoque multidisciplinario y un acceso quirúrgico adecuado al contexto.

Objective: To present a clinical case and discuss the management of axillary artery trauma and to review current literature. Clinical case: Male patient with axillary artery injury, who is brought in hypovolemic shock to the Emergency Department. Surgical findings demonstrated an incomplete section of the second portion of the axillary artery which was repaired with primary end-to-end anastomosis. Postoperatively, the patient evolves without pain and is discharged. Discussion: The management of vascular trauma should be methodical and multidisciplinary. Hard signs of vascular trauma mandate immediate surgical exploration. Patients with soft signs may need further evaluation with images. In an incomplete section of the axillary artery the end-to-end anastomosis has shown good results. Conclusions: Axillary artery lesions in the context of trauma are infrequent. Its management requires a high index of suspicion, a multidisciplinary approach and adequate surgical access.

Variations In Lateral Root Of Median Nerve

Background: Median nerve is formed in axilla by medial & lateral roots from medial & lateral cords of brachialplexus respectively. Variations of median nerve are not uncommon. Incidences of variations in lateral root aremore common than that of medial root. This study was undertaken to find out the different ways by which lateralroot contributes in formation of median nerve. These finding will provide anatomical basis for clinical correlationin case of neuropathies & surgeries of upper limb.Materials and Methods: 80 upper limbs were dissected to find out the variations of the lateral root in theformation of median nerve.Result and findings: Median nerve was formed in the axilla: - by one medial root & two lateral roots in 16.25%cases, one lateral root was thin & and the other was thick in 2.5% cases, 2nd lateral root joined the median nervein middle third of arm in 2.5 % cases. In 11.25 % cases median nerve was formed in the middle 1/3rd of arm bymedial & lateral root, 2nd lateral root joined it at lower 1/3rd of arm. In 2.5 % cases two small lateral roots joinedthe medial cord before it branched into ulnar nerve and medial root of median nerve ,a 3rd lateral root joined themedial root to form the median nerve. In 8.75 % median nerve was formed in axilla by one medial & two lateralroots; a 3rd lateral root joined it at lower part of axillaConclusion: Though, formation of median nerve by several lateral roots is considered to be a rare variation, inour study we observed 41.25% variations of different types.

Unilateral Variation In Branching Pattern Of Third Part Of Left Axillary Artery: A Case Report

The Axillary artery is the continuation of the subclavian artery and is a major artery of the upper limb. During theroutine dissection for undergraduate Ayurvedic medical students of SDM Trust’s Ayurvedic Medical College,Terdal, Bagalkot, Karnataka, India, in the department of anatomy we come across a variation in branchingpattern of third part of left axillary artery in male cadaver approximately 55 years of age. The first part and thesecond part of left axillary artery branches were found to be normal but third part of left axillary artery presentingonly one common trunk. This common trunk running posteriorly and dividing into subscapular artery, Anteriorcircumflex Humeral Artery, Posterior circumflex Humeral Artery and profunda brachii artery.

Bilateral Abnormal Course Of Brachial Artery Related With The Median Nerve In Arm: A Case Report

Many formative variations of median nerve are known but this variant formation and course of median nerve israre. A variant formation of median nerve was noted in the axilla and arm of a male cadaver, in the form offormation of median nerve behind the third part of axillary artery and brachial artery wind around mediannerve. There may be compression of the nerve passing around the artery. This variation may be clinicallyimportant because symptoms of median nerve compression arising from similar variations are often confusedwith more common causes such as radiculopathy and carpal tunnel syndrome.During routine dissection, one of the cadaver showed bilateral abnormal course of brachial artery in the arm. Inthe right arm: In the axilla, median nerve present posterior to the artery. In the left arm: brachial artery twistingaround the median nerve. At the level of the neck of radius brachial artery dividing into radial and ulnar arteriesin both side of upper limb.