Management of upper limb arterial injury without angiography—Chennai experience

Vivekanandan, Subramanian; Velu, Ramesh; Subramaniyan, Siva; Hussain, SA; Natarajan, Sekar

doi:10.1016/s0020-1383(03)00237-7

Cited by 27 publications

(8 citation statements)

References 12 publications

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“…The results of civilian UEVI were impressive in series with a high incidence of penetrating injuries. The amputation rate in these series ranged from 0 to 3.7% [8–11]. However, there is still a significant mortality rate (5.2–39.0%) in these series, especially for patients with penetrating injuries of the subclavian artery [8–10].…”

Section: Discussionmentioning

confidence: 99%

Management of Upper Extremity Vascular Injury: Outcome Related to the Mangled Extremity Severity Score

et al. 2009

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MESS, an outcome score used to grade the severity of extremity injuries, correlates well with the risk of amputation. Nevertheless, a MESS of >or=7 does not always mandate amputation. On the other hand, the MESS is a better predictor for patients who do not require amputation when the score is <7. The decisions to amputate in patients should be made individually based on clinical signs and an intraoperative finding of irreversible limb ischemia.

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Section: Discussionmentioning

confidence: 99%

Management of Upper Extremity Vascular Injury: Outcome Related to the Mangled Extremity Severity Score

et al. 2009

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“…With the clinical signs, the diagnosis and decision are supported by arterial duplex ultrasound examination, as many previous international studies have concluded that arterial duplex ultrasonography is a non-invasive, cost-effective, and easy bedside test; it reported 99% sensitivity and 98% accuracy in the diagnosis of brachial artery injuries. 14,15 Computed tomography angiography was used in only three cases with occlusive non-bleeding injuries to confirm the diagnosis, despite the controversial discussion in previous research studies regarding the limited role of angiography in the diagnosis of brachial artery injuries in upper-arm traumas. 1,4,16 To provide a clear explanation of the mechanism and pathophysiology of the penetrating gunshot injuries of the upper-extremities, a good understanding of the anatomical background and its features is required.…”

Section: Discussionmentioning

confidence: 99%

Brachial artery injuries - the impact of the anatomical site of injury on postoperative outcomes

et al. 2022

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Background:The start of the armed conflicts in Libyan society in 2011 led to a dramatic increase in the incidences of unusual types of brachial artery injuries, which were previously uncommon. In this study, the postoperative outcomes have been compared prospectively between patients who have had injuries at the proximal anatomical half of the brachial artery with those who suffered injuries at the distal anatomical half. Methods: A cohort study was undertaken to compare patients who had an injury at the proximal anatomical half of the brachial artery (considered as the first group) and patients who had an injury at the distal anatomical half of the brachial artery (considered as the second group). This was undertaken to analyse the influence of the anatomical site of injury on the postoperative outcomes in patients who underwent urgent surgical repair procedures at the hospital from February 2011 to December 2016. Results: Out of fifty-one patients, 31 (60.8%) patients had gunshot injuries, 12 (23.5%) had explosive injuries, four (7.8%) had stab wounds and four (7.8%) were victims of road traffic accidents. There were 13 (25.5%) patients in the first group and 38 (74.5%) patients in the second group. Three patients (5.9%) had postoperative arterial occlusion due to thrombosis, while two (3.9%) had postoperative graft occlusion due to thrombosis; the other two (3.9%) had compartment syndrome. Conclusion:Based on the anatomical background, critical limb ischaemia and postoperative ischaemic complications, as well as delayed limb amputation, are more associated with the injuries to the proximal anatomical half of the brachial artery due to poor collateral circulation at this level.

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“…Early diagnosis, increased surgical experience, and developments in the treatment of hypovolemic shock and the use of antibiotic therapy also improved survival of the patient. 2,7,8 Associated morbidity and mortality rates with brachial artery injuries depend on the cause of the injury itself, which vein or tendon is injured, and whether musculoskeletal and nerve injuries are also present.…”

Section: Discussionmentioning

confidence: 99%