Brachial Artery Thrombosis Research Articles

A Case of Needle-Directed Pulse-Spray Pharmacomechanical Thrombolysis of Acute Brachial Artery Thrombosis

AbstractAcute limb ischemia is a serious disabling condition. The management options depend upon the patient symptoms and signs of ischemia in the affected limb. The management options include surgical thrombo-embolectomy and catheter directed thrombolysis. Catheter directed thrombolysis has now become the first line of management in symptomatic cases. Here, we discuss a case of acute left brachial artery thrombosis which was successfully managed by needle-directed pulse-spray thrombolysis.

Brachial Artery Thrombosis in an 8-year-old Boy with Antiphospholipid Antibodies Induced by Mycoplasma pneumoniae Infection: a Case Report

Brachial Artery Thrombosis in an 8-year-old Boy with Antiphospholipid Antibodies Induced by <i>Mycoplasma pneumoniae</i> Infection: a Case Report

Intravenous immunoglobulins for rheumatic disorders and thromboembolic events-a case series and review of the literature.

To report the temporal association between a series of thromboembolic events and intravenous immunoglobulin infusion in patients with rheumatic diseases, and to review the literature on the subject. The clinical presentation, course, and outcome of thromboembolic events occurring post-immunoglobulin infusion in nine patients is described. A web-based literature review using the PubMed database from 1996 to 2017 was performed, searching for the keywords: thrombosis, thromboembolism, intravenous immunoglobulin, pulmonary embolism, deep vein thrombosis, cerebrovascular event, and acute myocardial infarction. Nine patients who had suffered a thromboembolic event within a week after receiving an intravenous immunoglobulin infusion (Omr-IgG-am™, OMRIX) were identified among our joint cohort. All patients except one were female ranging in age from 22 to 69years. Five had progressive systemic sclerosis (one of them had progressive systemic sclerosis with antiphospholipid syndrome, and another had an overlap of progressive systemic sclerosis with systemic lupus erythematosus), the sixth had monoclonal IgM autoimmune neuropathy, the seventh had systemic lupus erythematosus with antiphospholipid syndrome, the eighth had granulomatosis with polyangiitis (GPA) and the ninth had overlap autoimmune syndrome. Six of the patients had an arterial thrombosis: an acute myocardial infarction in four, a brachial artery thrombosis in the fifth, and a cerebrovascular attack in the sixth. Three patients sustained a venous thrombosis and/or an acute pulmonary embolism (one of them had a DVT with the PE). Two events occurred during the IVIG infusion, three within an hour after the last infusion of the 5-day course, one occurred a few hours after the initiation of the IVIG therapy, another occurred 3days after receiving the final infusion of the 10th course, and two events occurred a week after the treatment course has ended. Fifty-five percent of the patients had no thrombogenic risk factors other than their rheumatic condition, and most of them had received numerous, uneventful IVIG treatment courses before sustaining the thromboembolic event. No immediate deaths occurred among this cohort. Thromboembolic events after IVIG infusions, although infrequent, may occur in rheumatic patients, even in the absence of other recognizable risk factors for thromboembolism. The reported events had occurred despite complying with recommended guidelines for IVIG administration, which include a lengthy 8-h infusion and division of the total dose. No correlation was found between the number and frequency of the infusions to the thromboembolic events. Heightened awareness of possible thromboembolic events in rheumatic patients is encouraged for at least a week following IVIG administration.

Outcomes of Brachial Artery Access for Endovascular Interventions

A percutaneous brachial artery (BA) approach is a suitable or even favorable alternative to femoral artery access when performing certain endovascular interventions. However, this approach may have a higher complication rate compared to femoral artery access. We analyzed our results using percutaneous BA approach for noncardiac endovascular interventions. Between January 1, 2003 and December 31, 2017, BA access was used in 157 cases performed on 136 patients. The procedures included 102 (65%) therapeutic interventions and 55 (35%) diagnostic studies. The vessels studied or treated included lower extremity arteries (48), the aorta and iliac arteries (45), mesenteric arteries (45), failing arterial revascularizations (24), renal arteries (9), subclavian arteries (8), carotid arteries (2), and visceral aneurysms (2), or in conjunction with endovascular aneurysm repair (EVAR), fenestrated EVAR, or thoracic EVAR (8). More than 1 vessel was studied or treated in 34 cases. Sheath sizes included 5F in 38 (24%) cases, 6F in 93 (59%) cases, and 7F in 26 (17%) cases. Percutaneous puncture was utilized in 142 (90.4%) cases and planned surgical exposure with primary closure of the BA in 15 (9.6%) cases (10, 7F; 4, 6F; 1, 5F). Manual compression was used for hemostasis at the conclusion of all percutaneous cases. There were 2 (1.3%; 2/157 cases) deaths in the perioperative period, one due to myocardial infarction and the other from mesenteric ischemia. Access site complications occurred in 10.6% (15/142) of percutaneous cases, which required open surgical repair for bleeding (8) and BA thrombosis (7). There was an increased risk of complications with increasing sheath size in the percutaneous approach: 5.4% (2/37), 12.4% (11/89), and 12.5% (2/16) for 5F, 6F, and 7F sheaths, respectively (P=0.49). None of the 15 patients who underwent surgical treatment suffered long-term vascular or neuropathic complications. In our experience, percutaneous BA access was associated with a 10% complication rate with an increased risk of complications associated with increasing sheath size. There was approximately the same incidence of bleeding as thrombosis. For patients who require 6 or 7F sheaths via a BA approach, we recommend more liberal use of open surgical exposure and primary BA repair.

Brachial artery thrombosis due to a giant, stented arteriovenous fistula aneurysm in a renal transplant patient

Brachial artery thrombosis due to a giant, stented arteriovenous fistula aneurysm in a renal transplant patient

Microvascular surgery in the congenital cardiac patient: A case series exploring feasibility and practical applications

Pediatric congenital heart disease patients are at risk for vascular injuries during surgical procedures or when the arterial system is accessed for monitoring or diagnostic studies. Our treatment of emergent situations in this patient population using microvascular techniques shows the feasibility of such techniques. A retrospective chart review of patients aged 0-18 years with congenital heart disease identified six patients who underwent microvascular surgery by the senior surgeon from June 2007 to May 2015. We studied this series, highlighting technical aspects of surgery and perioperative care to determine their effect on outcome. Six patients with congenital cardiac defects requiring cardiothoracic surgery were studied, body weight ranging from 3.2 to 19.1kgat the time of surgery. Five suffered iatrogenic arterial injury to the heart or vessels used for access or diagnostic studies, including coronary artery laceration, brachial artery thrombosis, and external iliac artery avulsion. Interventions included direct end-to-end repair and vein grafting. Vessel diameter averaged 1 mm. Patients received vasopressors intraoperatively and were on vasopressors and antihypertensives postoperatively. One patient died because of disseminated intravascular coagulation on postoperative day 17, but bypass graft was patent prior to death. The rest survived with clinical evidence of patency of the repaired vessel for a long-term. Microsurgical intervention may be life-saving as a revascularization procedure to the heart by direct coronary repair or bypass grafting. Iatrogenic injuries to the limb may cause critical ischemia; limbs can be salvaged by microsurgical repair. Despite technical and physiological challenges, microsurgery is feasible and sometimes crucial in this patient population.

Intrauterine Bilateral Upper Limb Gangrene and Cerebral Infarction in Preterm Infant: A Case Report and Literature Review

Intrauterine limb gangrene with cerebral infarction is a rare condition and only few cases of this condition have been reported. The neonatal thrombosis needs to be distinguished from intrauterine arterial thrombosis as it is caused by catheterization of the umbilical artery or less commonly seen as complication of sepsis or coagulation disorders. The report describes the case of preterm infant with bilateral brachial artery thrombosis in utero and neonatal gangrene of the left forearm. The right forearm of the infant had a small patch of gangrene with irregular areas of edema and bluish discoloration, extending to the hand. The hand of infant was associated with thrombosis of left middle cerebral artery and acute infarction in left cerebral hemisphere. Both of the upper limbs in the patient were affected, including the left cerebral hemisphere; although in majority of the cases, the limbs are equally affected and the left side of the brain is preferentially involved. LMWH was administered in the present case, which significantly improved the upper right limb. Laboratory findings, including the coagulation markers within normal reference, ranges for the chronologic and gestational age. Further complications were prevented by early post-natal use of anticoagulants and prevention of infection; although the exact cause of this condition was not clear.

Akut üst ekstremite arteryel embolileri: 2 yıllık klinik deneyimimiz

Objective: Extremity thromboembolism is a serious cause of morbidity and mortality in cardiovascular diseases. Comparing with the lower extremity arteries, upper extremity acute arterial occlusions are rarer and constitute 15-32% of all cases. Trauma, collagen vascular diseases, malignant tumors, myxoma, subclavian artery stenosis, myocardial infarction and thromboangiitis obliterans are often identified as etiologic factors. The first option in the treatment of these patients is surgical embolectomy. Endarterectomy, patchplasty and arterial bypass operations can be counted in treatment options of chronic patients. Material and Methods: In this study, we retrospectively analyzed clinical features and prognosis of 58 patients consisting of 31 women and 27 males who were admitted to our emergency department with acute arterial embolism. Results: Mean age of our group was 67.05±17.09. Proximal brachial artery thrombosis was found in 3 patients. The other 55 patients had thrombosis in the brachial artery and its distal branches. After the diagnosis of patients in the emergency room 100 units/kg of subcutaneous enoxaparine was applied. Selective arterial embolectomy surgery was performed under local anesthesia in all patients with access from the antecubital region. Arteriotomy was closed using saphenous patch plasty technique in two patients. Compared with preoperative demographic data and thromboembolism etiology, 21 (36%) patients were diagnosed as atrial fibrillation. Those patients had not been followed and treated for atrial fibrillation. In 5 (8.6%) patients malignancy was detected as an etiologic factor. Four (6.8%) patients died during their follow-ups in the clinic, 3 (75%) of those patients had an atrial fibrillation. Conclusion: Acute peripheral arterial occlusion constitutes a significant part in emergency vascular surgery. Therefore early diagnosis and prompt surgical treatment are very important for the results. Atrial fibrillation (AF) holds an important place in upper extremity acute arterial occlusion, but other etiological factors such as malignancy is necessary to not forget. AF who has acute upper extremity arterial embolism patients with AF have higher mortality rates and the clinical management and treatment of those patients must be monitored more closely. We believe that the development of treatment modalities and further work needs to be done in order to find an appropriate treatment.

Acute brachial artery thrombosis with diabetic ketoacidosis

Background: Diabetes Mellitus is a worldwide disease that leads to several acute complications including diabetic ketoacidosis. Diabetic ketoacidosis is usually preceded by infection, acute myocardial infarction, stroke, or other dire events. There is one report where diabetic ketoacidosis was reported to be associated with acute arterial embolism. Acute arterial thrombosis is a rare disease that requires immediate treatment. Methods: We present a diabetic patient who presented with acute arterial embolism and developed diabetic ketoacidosis. This is the first case in our hospital in which we have reported with acute brachial artery thrombosis and DKA. Results: We present a 68 years old male chronic smoker with a 25 year history of type 2 Diabetes (non-compliant to medications), Peripheral vascular disease, dyslipidemia and transient ischemic attack. He experienced severe pain and numbness in his right arm and forearm with no wound, puncture lesion or ecchymosis. Forearm was cold, pale with delayed capillary refill on right hand. Right brachial, right radial and right ulnar arteries were not palpable. Strong pulsations of the right subclavicular and right carotid arteries were palpated. This led to a strong suspicion of an acute thrombosis of the right brachial artery. Emergency thrombectomy with +/ − fasciotomy was planned. Patient was anticoagulated with intravenous heparin. Patient's blood sugar was persistently elevated and blood gases showed mild acidosis. Urinary examination confirmed presence of diabetic ketoacidosis. Conclusions: A high index of suspicion of diabetic ketoacidosis in patients with acute arterial thrombosis may lead to early recognition and treatment, avoiding any adverse outcome.

TCTAP C-128 Acute Brachial Artery Thrombosis Associated with Heparin-induced Thrombocytopenia After Transradial Coronary Intervention

### Patient initials or identifier number LOR, 1267524 ### Relevant clinical history and physical exam A 74-year-old woman presented to the emergency room with chest discomfort and shortness of breath. She had no history of chronic medical illness. On admission, her blood pressure was 140/90

Feasibility of endovascular repair of splenic artery aneurysms using stent grafts

Percutaneous transcatheter embolization of splenic artery aneurysms (SAAs) has been widely accepted as the first line of treatment in patients with symptoms, rupture, or large aneurysm size. Although embolization can usually be performed safely, ischemic complications, such as splenic infarct or abscess, occur in some patients. This study evaluated the feasibility and outcomes of endovascular SAA repair (ESAAR) using stent grafts, which may allow treatment while preserving flow to the spleen. We reviewed the clinical data of all consecutive patients who underwent ESAAR using stent grafts. Brachial access was used except for patients with favorable angle of origin from the aorta. To overcome tortuosity and provide support, a coaxial system with a hydrophilic sheath was used. Low-profile 0.018-inch stent grafts were used for distal SAAs with a 10-mm to 15-mm length of proximal and distal segment of splenic artery measuring 4 to 11 mm in diameter. Follow-up included clinical examination and computed tomography imaging within 4 to 6 months after the procedure and yearly thereafter. End points were morbidity, stent graft patency, and freedom from endoleaks and reinterventions. ESAAR was attempted in 10 patients, four males and six females, with median age of 64 years (range, 48-77 years). Median SAA size was 2.8 cm (range, 2-5.7 cm). Nine patients were asymptomatic, and one had pancreatitis and gastrointestinal bleeding. The arterial access site was the brachial artery in six patients and the femoral artery in four. Two patients had brachial and femoral access to facilitate splenic artery stenting. Technical success of ESAAR using stent grafts was 80% (8 of 10). In two patients with distal SAAs, stent graft placement was not possible due to excessive vessel tortuosity, and treatment was by coil embolization. One patient developed brachial artery thrombosis, which was treated surgically. There were no ischemic complications in patients treated by ESAAR with stent grafts. Median length of stay was 1 day. One patient treated by coil embolization developed splenic infarct, which required readmission for pain control. Median follow-up was 9 months. Follow-up imaging in all successfully stented patients revealed patent stent grafts, no endoleak, and no aneurysm sac enlargement. No reinterventions were required. ESAAR using self-expandable stent grafts offers a viable alternative to coil embolization in selected patients with SAAs. Distal SAAs with excessive vessel tortuosity may result in technical failure requiring embolization. Among patients who underwent successful ESAAR, there were no ischemic complications, stent graft occlusions, endoleaks, or sac enlargement.

Late Brachial Artery Thrombosis after Supracondylar Humeral Fracture at 5 Years Old Boy

Supracondylar fractures in children is a well known problem, but late neuro-vascular complications related to the fractures of the distal part of the humerus in children are rare. There has been presented the case of a patient after a supracondylar fracture with slow brachial artery thrombosis.

Brachial Artery Injury Caused by Camel Bite

We present a rare case of brachial artery thrombosis following a penetrating injury on the right arm following a camel bite. A 57-year-old man presented with arm pain following a camel bite to the right arm. Brachial, radial and ulnar pulses were not palpable. Neurological examination revealed no motor deficit. Intraoperatively the brachial artery was thrombosed, thromboembolectomy was done following that the limb pulses were restored.

Low incidence of tendon rerupture after distal biceps repair by cortical button and interference screw

The use of cortical suspensory fixation in conjunction with an interference screw to treat distal biceps ruptures has yielded favorable results. However, literature examining the incidence of fixation failure in a large consecutive series of patients treated with this technique is lacking. A retrospective review of electronic medical records identified 170 distal biceps ruptures in 168 consecutive patients (164 men and 4 women) treated using a cortical button in conjunction with an interference screw. The study group was an average age of 48 years (range, 20-71 years). Records were reviewed from the time of the initial clinic visit to the most recent follow-up. Early failures were defined as those that occurred within 12 weeks of the index procedure. Failed repair was defined as tendon defect, deformity, or significant weakness in supination. The early incidence of failure was 1.2%, with 2 of the fixations meeting the criteria for failure. One patient had significant brachial artery thrombosis. Other complications included posterior interosseous nerve palsy, lateral antebrachial cutaneous nerve-related complication, and numbness about the radial nerve. The use of a cortical suspensory fixation device in conjunction with an interference screw is an effective method of repairing a distal biceps rupture, with a low early rate of failure.

Catheter-induced brachial artery thrombosis in the neonate

Acute arterial thrombosis is a rare complication of brachial artery cannulation that can threaten the viability of the affected limb. We present a case of a premature male neonate who suffered complete thrombosis of the brachial artery following multiple failed attempts at cannulation. He subsequently underwent emergent thrombectomy, resection of the involved vessel segment, and primary microanastomosis with good recovery. Keywords : brachial artery, neonatal surgery, thrombosis

Accidental Intra-arterial Cannulation: an Unusual Case.

Dear editor, Mrs X, 21 years old G3P2 with premature rupture of membranes at 41 weeks gestation, had intravenous cannulation in cubital fossa for oxytocin augmentation. Oxytocin infusion was continued for 10 h. Thereafter, she was given intravenous injections of ampicillin and gentamicin. Immediately after injection, oedema of the forearm was noted which was thought to be due to extravasation of drug. Cannula was immediately removed, and magnesium sulphate ointment was applied locally. After 4 h, massive oedema and cyanosis were noticed in the forearm and hand distal to the cannula with absent radial pulsations, leading to a provisional diagnosis of brachial artery thrombosis. Urgent vascular surgeon consultation was obtained. By this time, cervix was fully dilated and patient delivered vaginally a 3-Kg baby, following which thromboembolectomy was done. Post thromboembolectomy, ultrasound Doppler revealed short segmental thrombus of the right brachial artery in distal one-third of arm; ulnar artery patent for only a segment of 3 cm from its origin and radial artery and veins patent throughout. Postoperative care included broad spectrum antibiotics, vasodilators, anticoagulants, limb elevation and dressings. Blisters were noticed over the dorsum of hand on postnatal day 2; diagnosis of compartment syndrome was made for which fasciotomy was done. Repeated ultrasound Doppler after 2 months revealed occlusion of short segment of right brachial artery in cubital fossa, occlusion of right ulnar artery in forearm with multiple collaterals in forearm. Patient had complete resolution of sequelae with complete functioning of hand in 3 months. Accidental intra-arterial anaesthetic drug injections have been reported previously [1]. It has been proposed that lipid soluble drugs are more problematic, and brachial artery is associated with more tissue damage than radial or ulnar [1]. The immediate clinical presentations include pain, pallor in hand and cyanosis of fingers followed by extensive oedema of hand and forearm within 5 h. Extensive injury includes nerve damage, compartment syndrome, thrombosis and gangrene leading to eventual amputation [2]. In this case, significant time elapsed before arterial catheterisation was discovered resulting in disastrous outcome. In summary, vigilance is the best therapy. An indwelling catheter not functioning properly should never simply be assumed to be positional. Alarming signs include marked increase in blood pressure on flushing the line, bright red appearance of blood, more intense pain than expected, distal signs of ischaemia, manual palpation of arterial pulse proximal to the catheter and retrograde pulsatile blood flow. Diagnosis is by pressure transducer or blood gas analysis. Treatment recommendations include continuous heparin infusion for 24 h which, if done immediately, leads to no sequelae; sympathetic blockage with brachial plexus block, stellate ganglion block and general anaesthesia for further sympatholysis, postoperative limb elevation and maintenance of warmth, intra-arterial vasodilators and surgical exploration to extract thrombus and fasciotomy [2]. To conclude, a high index of suspicion of intra-arterial cannulation can prevent disastrous consequences. It is recommended that if suspicion is high, intravenous catheterisation should be repeated unless situation is extremely dire and no other intravenous access is readily obtainable.

Ultrasound-guided percutaneous thrombin injection of iatrogenic upper extremity pseudoaneurysms

The objective of this study was to evaluate the safety and efficacy of ultrasound-guided thrombin injection (TI) for the treatment of upper extremity iatrogenic pseudoaneurysms (PAs) after percutaneous upper extremity arterial access. This is a retrospective single-institution study from January 2009 to December 2012. All patients with clinical suspicion of an upper extremity PA after arterial puncture underwent duplex examination. Patients with and without PAs were compared to identify risk factors for development of PAs. Outcomes were analyzed in those patients with PAs that were treated with TI. Between January 1, 2009, and December 31, 2012, there were 61 upper extremity arterial duplex examinations performed for a clinical suspicion of an upper extremity PA. Eighteen ultrasound examinations (29.5%) demonstrated an iatrogenic upper extremity PA (13 brachial and five radial). Those patients with an upper extremity PA were more likely to have a history of hypertension, atrial fibrillation, and chronic kidney disease. Sheath size, preprocedural antiplatelet therapy, periprocedural anticoagulation regimen, service specialty performing the procedure, and procedure type did not influence the development of PA. Of 18 patients with PA, 14 were treated with TI with an overall success rate of 86%. There was one PA that failed to thrombose with TI, and there was one native brachial artery thrombosis requiring emergent surgical intervention. Outpatient clinical follow-up in the successfully treated patients demonstrated no recurrences at an average follow-up of 8 months. Ultrasound-guided percutaneous TI appears safe and effective for the treatment of iatrogenic brachial and radial artery PAs.

Acute Brachial Artery Thrombosis in a Neonate Caused by a Peripheral Venous Catheter

This case describes the diagnostic testing and management of an acute thrombosis of the brachial artery in a female neonate. On day seven of life, clinical signs of acutely decreased peripheral perfusion indicated an occlusion of the brachial artery, which was confirmed by high-resolution Doppler ultrasound. Imaging also showed early stages of collateralization so that surgical treatment options could be avoided. Unfractionated heparin was used initially and then replaced by low-molecular-weight heparin while coagulation parameters were monitored closely. Within several days, brachial artery perfusion was completely restored. Acetylsalicylic acid was given for additional six weeks to minimize the risk of recurring thrombosis. If inadequately fixated in a high-risk location, a peripheral venous catheter can damage adjacent structures and thus ultimately cause arterial complications.

Brachial Artery Injuries in Children

Treatment of brachial artery injuries in children, particularly those resulting from supracondylar humeral fractures, is controversial when distal pulses are absent yet the hand remains warm and pink. This article presents a retrospective study of eight children, ages 3 to 13, who underwent brachial arterial exploration because of absent distal pulses following arm trauma. Absent pulses indicate diminished blood flow, and in all eight cases brachial artery obstruction or severance was confirmed at surgery. In four of the children, who presented with cold, devascularized hands as a result of posterior elbow dislocations, supracondylar humeral fracture, or dog bites, there is no debate regarding revascularization. The other four children, with type III supracondylar humerus fractures, had pulseless, pink hands as a result of brachial artery thrombosis or arterial tethering. Brachial artery flow was reestablished in all cases with return of distal pulses, and no vascular complications. The authors believe that artery exploration is indicated when distal pulses are not present.

Intrauterine upper limb ischemia: an unusual presentation of fetal thrombophilia-a case report and review of the literature.

Upper limb ischemia presenting in neonatal period is extremely rare. Moreover, presenting newborn with evidence of intrauterine upper limb vascular occlusion is even rarer. It needs prompt intervention to restore perfusion and avoid morbidity. We present a newborn with right upper limb brachial artery thrombosis causing ischemia that was noted at birth and appeared later to be homozygous for factor V Leiden and glycoprotein IIIa with no other identifiable risk factors. In this report, we present the case, its successful medical management, proper counseling, and review of the literature. We recommend investigating the neonates and their parents for thrombophilia mutations when they present with unusual vascular occlusion site as newborns.