Bilateral Axillary Artery Aneurysms Presenting as Upper Limb Ischemia

2015 ◽  
Vol 29 (8) ◽  
pp. 1659.e9-1659.e12 ◽  
Author(s):  
Kimihiro Igari ◽  
Toshifumi Kudo ◽  
Takahiro Toyofuku ◽  
Yoshinori Inoue
Vascular ◽  
2014 ◽  
Vol 23 (6) ◽  
pp. 653-656
Author(s):  
Christos Argyriou ◽  
George S Georgiadis ◽  
Michael Mantatzis ◽  
Nikolaos G Schoretsanitis ◽  
George A Antoniou ◽  
...  

Aim Hybrid vascular interventions performed in patients with chronic limb ischemia are considered minimally invasive techniques for treating complex multilevel arterial occlusive disease. Methods We report the case of a 42-year-old woman with a critical upper limb ischemia, who underwent angioplasty and secondary stenting of the distal-third of the axillary artery followed by a brachial–brachial bypass using an autologous graft. Results The patient had an uneventful recovery. To our knowledge, this is the first case reported in the literature of hybrid vascular reconstruction in the upper limb due to atherosclerosis. Conclusion Hybrid revascularization procedure in the upper limb is technically feasible, safe for the patient, and should become a part of the armamentarium of the modern vascular surgeon.


VASA ◽  
2008 ◽  
Vol 37 (4) ◽  
pp. 327-332 ◽  
Author(s):  
Koutouzis ◽  
Sfyroeras ◽  
Moulakakis ◽  
Kontaras ◽  
Nikolaou ◽  
...  

Background: The aim of this study was to investigate the presence, etiology and clinical significance of elevated troponin I in patients with acute upper or lower limb ischemia. The high sensitivity and specificity of cardiac troponin for the diagnosis of myocardial cell damage suggested a significant role for troponin in the patients investigated for this condition. The initial enthusiasm for the diagnostic potential of troponin was limited by the discovery that elevated cardiac troponin levels are also observed in conditions other than acute myocardial infarction, even conditions without obvious cardiac involvement. Patients and Methods: 71 consecutive patients participated in this study. 31 (44%) of them were men and mean age was 75.4 ± 10.3 years (range 44–92 years). 60 (85%) patients had acute lower limb ischemia and the remaining (11; 15%) had acute upper limb ischemia. Serial creatine kinase (CK), isoenzyme MB (CK-MB) and troponin I measurements were performed in all patients. Results: 33 (46%) patients had elevated peak troponin I (> 0.2 ng/ml) levels, all from the lower limb ischemia group (33/60 vs. 0/11 from the acute upper limb ischemia group; p = 0.04). Patients with lower limb ischemia had higher peak troponin I values than patients with upper limb ischemia (0.97 ± 2.3 [range 0.01–12.1] ng/ml vs. 0.04 ± 0.04 [0.01–0.14] ng/ml respectively; p = 0.003), higher peak CK values (2504 ± 7409 [range 42–45 940] U/ml vs. 340 ± 775 [range 34–2403] U/ml, p = 0.002, respectively, in the two groups) and peak CK-MB values (59.4 ± 84.5 [range 12–480] U/ml vs. 21.2 ± 9.1 [range 12–39] U/ml, respectively, in the two groups; p = 0.04). Peak cardiac troponin I levels were correlated with peak CK and CK-MB values. Conclusions: Patients with lower limb ischemia often have elevated troponin I without a primary cardiac source; this was not observed in patients presenting with acute upper limb ischemia. It is very important for these critically ill patients to focus on the main problem of acute limb ischemia and to attempt to treat the patient rather than the troponin elevation per se. Cardiac troponin elevation should not prevent physicians from providing immediate treatment for limb ischaemia to these patients, espescially when signs, symptoms and electrocardiographic findings preclude acute cardiac involvement.


2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Alosaimi Roaa ◽  
Albajri Ahood A ◽  
Albalwi Roaa M
Keyword(s):  

Author(s):  
Vikram S. ◽  
Saraswathi Devi H.N.

Medical science says that ischemia is a common complication in Diabetes, especially in the lower limb but this is a case presenting ischemic changes in upper limb which is unique and also in such type of acute ischemia amputation is the only choice of treatment to save the life of patient from septicaemia. Such a rare and interesting case was taken at Sri Sri Ayurveda Hospital and handled by proper Ayurvedic line of treatment by which circulation is re-established which saved both limb and life of patient. A patient by name Sundaramma, 62yr Female, visited Sri Sri Ayurveda Hospital on 29/2/2016 with a diagnosis of Right upper limb Ischemia with Diabetes Mellitus and Active TB. The main symptoms were severe pain and burning sensation in Right hand and forearm, discolouration of fingers with ulcers, Bluish black discolouration over right thumb, necrosis, pus dischargeand stiffness, associated with difficulty in movement of right arm, shoulder joint, elbow joint, palm and fingers. Diagnosed as Right Upper Limb Ischemia with Diabetes Mellitus and active TB. Therapeutic interventions like Right upper limb Doppler and CT angiogram were done. Such a complicated case was taken at Sri Sri Ayurveda Hospital, and carefully handled by Ayurvedic methods of management, which was ended up by preventing amputation of the limb and also achieving the re-establishment of arterial circulation.


Vascular ◽  
2005 ◽  
Vol 13 (2) ◽  
pp. 84-91 ◽  
Author(s):  
Jean Deguara ◽  
Tahir Ali ◽  
Bijan Modarai ◽  
Kevin G. Burnand

The objective of this study was to review a single center's experience of upper limb revascularization over 20 years. All patients undergoing operative or endovascular upper limb revascularization between June 1983 and July 2003 were identified. One hundred eighty-four upper limb revascularization procedures were carried out on 172 patients. Sixty-one patients had a thromboembolic event (35%), 53 patients presented with a traumatic vascular injury (31%), and 29 patients had symptoms of chronic atherosclerotic upper limb ischemia (17%). Fifteen patients had subclavian steal syndrome, eight patients had thoracic outlet compression, and six patients had iatrogenic injuries of the upper limb arteries. Fifty-five thromboembolectomies were performed, 37 under locoregional anesthesia. Ten patients (18.2%) died from cardiopulmonary causes following embolectomy. Fifteen reversed saphenous vein bypass grafts were performed for traumatic damage. Twenty-seven patients had a primary repair, and five required a vein patch. One patient subsequently had an arm amputation, and two patients died. Twelve patients presenting with chronic arm ischemia had a subclavian angioplasty, 12 patients had a proximal bypass, and in 5 patients, stenoses were stented. The mortality in this group was 6.9% (2 of 29). The mortality for upper limb revascularization was 8.7%. Almost all deaths occurred after upper limb embolectomy, and the mortality of this procedure was similar to that of lower limb embolectomy. Deaths were the result of cardiac comorbidity, and this should be actively sought and treated if outcomes are to improve.


Author(s):  
Marek Konarik ◽  
Vladimir Musil ◽  
Vaclav Baca ◽  
David Kachlik

Although the variability of the upper limb arteries is a clinically important problem, the prevalence varies across the existing studies and the classification is rather complicated, uncoined, and sometimes even unclear for its simple and direct understanding and usage. Multiple case reports appearing in the last years apply incorrect, inappropriate, and sometimes misleading terminology. Here we performed an anatomical cadaveric study of the variability of the arteries of the upper limb, namely the axilla, arm and forearm, in 423 upper limbs (Central European population) embalmed with the classical formaldehyde method. We proposed the application of the Equality system based on common trunks for denomination of the axillary artery branches principal variations: truncus subscapulocircumflexus (22.9%), truncus profundocircumflexus (13.75%), and truncus bicircumflexus (13.95%). Further, we proposed the terminology system developed by Rodríguez-Niedenführ et al. for the free upper limb principal arterial trunk variations based on the origin, location (in the arm only or in the arm and forearm), and course (related to the forearm flexor muscles) of the involved artery: arteria brachialis superficialis (9.5%), arteria brachioradialis superficialis (6.4%), arteria brachioulnaris superficialis (1.9%), arteria brachiomediana superficialis (0.5%), and arteria comitans nervi mediani manus (3.3%). Extensive development of the catheterisation methods via the arteria radialis et ulnaris as well as surgical procedures using flaps based on perforating branches of these arteries (including arteria brachioradialis superficialis et brachioulnaris superficialis) necessitate thorough data on the prevalence of the variant vessels for safe performance of these procedures and to prevent any unexpected situations or to react adequately when they occur.


2021 ◽  
Vol 20 ◽  
Author(s):  
Laishram Sophia ◽  
Darshita Singh ◽  
Neha Xalxo ◽  
Anjoo Yadav ◽  
Sneh Agarwal ◽  
...  

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.


2017 ◽  
Vol 23 (3) ◽  
pp. 142-149
Author(s):  
I. S. Tudorache ◽  
P. Bordei ◽  
D. M. Iliescu

AbstractOur study was performed by dissection on a number of 54 nervous trunks of the median nerve of the fetus. We found that the median nerve is always formed from two roots, their joining being at different levels of the upper limb, between the axilla and the elbow. The axilla nerve trunk was formed at the level of the axillary region, in 38.89% of the cases, in 22.22% of the cases the union was made at the middle part of the arm, and in 38.89% of the cases in the elbow. The lateral root of the medial nerve was formed in 55.56% of cases from a single nerve fascicle, in 44.44% of cases consisting of two nerve fascicles. The medial root was formed in 61.11% of cases from a single nerve fascicle, in 38.89% of the cases being made up of two nerve fascicles. In 27.78% of cases, the medial root passed behind the axillary artery. Regarding the volume of the two roots, we found that in 44.44% of the cases, the lateral root was more voluminous, in 27.78% of cases, the median root was larger and in 27.78% of cases, the two roots were approximately equal. We have encountered situations where a ramification for the forearms muscles emerged from the lateral root. Occasionally, a ram for the brachial muscle was detached from the medial root, and from the lateral root a ram for the biceps muscle, both muscles receiving branches also from the musculocutaneous nerve. We have encountered a single case where the median nerve inches the anterior muscles of the arm, missing the musculocutaneous nerve. In cases of low joining of the roots, we have encountered cases where a lateral root formed a ram for forearm muscles. The anastomoses between the two median nerve roots can sometimes be located just above their union or anterior to the lower portion of the axillary artery. In one case, we encountered between the two roots, above their union, the existence of three oblique anastomoses, the two upper ones from the lateral to the medial root, and the third from the medial root to the lateral root. Common are anastomoses between the roots of the roots and the root on the opposite side. The most common are the anastomosis between the medial fascicle of the lateral root and the medial root of the median nerve. In one case, we encountered a double overlap between the musculocutaneous nerve and the lateral nerve root. In one case, we encountered a strong anastomosis between the medial nerve fascicle of the medial root and the radial nerve. Common and at all levels of the upper limb are the anastomoses between the median and ulnar nerves. In the case of a low union of the two median roots, we encountered anastomoses between a root of the root and the ulnar nerve, or between a root and the ulnar nerve. I encountered a single case with an anastomosis, Martin- Gruber, which was previously passing through the ulnar and interos-like arteries and from which the anterior forearm muscles were detached.


2020 ◽  
Vol 7 (5) ◽  
pp. 1562
Author(s):  
Jitesh Tolia ◽  
Arvind Bhatt

Background: Arterial disorders of the upper extremity are much less common than those of the lower extremity, but when they result in symptoms of acute or chronic ischemia, surgical or endovascular techniques for upper extremity revascularization may be needed. This study presents a review of the epidemiology, aetiology, and clinical characteristics of upper limb ischemia.Methods: The records of 70 patients with upper limb ischemia who underwent treatment from were retrospectively reviewed.Results: A total of 44 patients were diagnosed by CT. Other diagnostic methods and tools used were conventional angiography and duplex ultrasound. Four cases were diagnosed solely on the basis of a medical history and physical examination. A total of 56 surgeries were performed. Rest of the 14 patients went under conservative therapy. The operations included embolectomy and thrombectomy using a Fogarty balloon catheter (n=32), bypass surgery using the great saphenous vein (n=10), percutaneous catheter-directed thrombolysis (n=8), and primary repair (n=4). Patients with Raynaud’s phenomenon or Burger’s disease were either treated with medication only (n=14) or with sympathectomy (n=2).Conclusions: The duration of symptoms in cases of upper limb ischemia may vary from two hours to a year, depending on the aetiology and severity of the illness. Many debates have addressed whether the time gap between the onset of symptoms and treatment predicts long-term arm function.


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