Evaluation of Doppler-derived indices at the brachial artery in predicting successful supraclavicular brachial plexus block.

The impact of arteriovenous anastomosis length on fistula flow rate and potential cardiovascular issues is not well established. However, it is widely recognized that proximal fistulas create a significant hemodynamic load, increasing the risk of high-output cardiac failure. Literature indicates that the anastomosis size varies from 3 to 15 mm. Nonetheless, common practice favors 6-10 mm for distal anastomoses, while the length reduces to 4-6 mm when the brachial artery is involved in the elbow or upper arm fistulas. It is advisable to avoid larger arteriotomies to prevent or lessen cardiovascular complications, especially when patients are monitored with access flow assessments and echocardiography for early detection of issues. Considering the high prevalence of elderly patients with cardiovascular risk among incident hemodialysis patients, a more careful approach to managing flow in arteriovenous access is crucial. The anastomotic length should be customized based on the patient's specific anatomical and physiological conditions, rather than applying a uniform standard.

Women with a history of preeclampsia (hxPE) have elevated risk of cardiovascular disease, likely in part from reduced endothelial function. Preeclampsia is also associated with increased risk of depression. While evidence indicates that antidepressant pharmacotherapy may have vasculoprotective effects, it is unclear whether it preserves endothelial function in women with hxPE. We hypothesized that antidepressant-treated women with hxPE would have preserved endothelial function compared with unmedicated women with hxPE. Ten women with hxPE currently treated with an antidepressant (hxPE+AD), 10 not treated (hxPE-AD), and 10 unmedicated women with a history of uncomplicated pregnancy (HC) participated. Macrovascular endothelial function was measured via brachial artery flow-mediated dilation (FMD). Microvascular endothelial function and the nitric oxide (NO) component were assessed via cutaneous vascular conductance (CVC, %max) responses to graded infusions of acetylcholine (10-10-10-1M) alone or with 15mM NG-nitro-L-arginine methyl ester [L-NAME; NO-synthase-inhibitor], respectively. Relative and absolute FMD in hxPE-AD were lower compared with HC (5.7±0.3% vs. 7.5±0.3%, P=0.02; 0.18±0.01mm vs. 0.23±0.01mm, P=0.02) and hxPE+AD (vs. 7.2±0.6% and 0.23±0.02mm, both P≤0.047). hxPE-AD had reduced microvascular endothelium-dependent vasodilation responses to acetylcholine compared with HC (10-5 to 10-2M, P=0.017). Peak CVC in hxPE-AD was lower than HC (82.0±2.9%max vs. 96.2±2.0%max, P<0.01) and hxPE+AD (vs. 92.3±3.4%max, P=0.04). L-NAME reduced microvascular dilation in all groups (P<0.001). NO-dependent dilation did not differ among groups (P=0.07). Collectively, macrovascular and microvascular endothelial function in hxPE+AD was greater than hxPE-AD and did not differ from HC, suggesting that antidepressant pharmacotherapy may preserve endothelial function in women with hxPE.

BackgroundPatients with chronic kidney dysfunction and on hemodialysis are subject to various infectious disease, including vascular access-associated infections (VAIs). However, the magnitude of VAI is not well investigated since nationwide surveillance of VAI has not been well established worldwide, except in the United States. In Japan, our group established a voluntary VAI surveillance scheme, Dialysis Surveillance Network Japan (DSN-J). The purpose of this study is to describe the epidemiology and risk factors for VAI in Japan.MethodsData collected through DSN-J from January 2008 to December 2023 were used. Incidence of VAI was calculated by the number of infection per 1,000 dialysis sessions. Profile of causative pathogens as well as potential risk factors including type of access, diabetes, indication of catheter use and seasonality were analyzed.ResultsDuring the study period, 5,907,641 dialysis sessions were surveyed at 52 hospitals. 1,350 VAIs were observed, with an overall incidence of 0.23 per 1,000 sessions. The annual incidence steadily declined over time. The incidence of VAI caused by non-cuffed catheter (NCC) was 7.75 (663 VAIs in 85,525 sessions). This was significantly higher than that with other access type (0.05 for arteriovenous fistula, 0.10 for superficialization of brachial artery, 0.49 for arteriovenous graft, and 1.39 for cuffed catheter (CC), respectively). The dominant causative pathogen was methicillin-susceptible Staphylococcus aureus (306 VAIs), followed by methicillin-resistant Staphylococcus aureus (227). Diabetic patients had a significantly higher risk of VAI than non-diabetic patients when they were on dialysis with NCC (Relative risk[RR]:1.24, 95%CI:1.04-1.47), but not so when with CC (RR:0.78, 95%CI:0.60-1.01). NCC inserted at the femoral site had significantly higher risk of VAI compared to that at internal jugular site (RR 1.46, 95%CI: 1.22-1.74). The incidence of VAI in summer (May to October) was substantially higher than that in winter (November to April), especially in patients with arteriovenous fistula or CC.ConclusionThe overall incidence of VAI is low, however that in NCC was unacceptably high. The epidemiology and risk factors identified through this research would help better control VAIs in patients on hemodialysis.DisclosuresAll Authors: No reported disclosures

HeRO's Don't Always Win: Evaluating HeRO grafts in contemporary dialysis access.

Purpose: Aerobic exercise interventions improve peripheral endothelial function in healthy older males. This effect is inconsistently observed in healthy postmenopausal females, and possible mechanisms underlying this sex-related difference remain unknown. We tested the hypothesis that endothelial sensitivity to exercise-induced shear rate is reduced in healthy postmenopausal females and that it can be improved by acute folic acid consumption. Methods: Using a double-blind randomized crossover study design, 17 postmenopausal females (66 ± 8 years) and 14 males (66 ± 6 years) performed handgrip exercise at 20%, 40%, 60%, and 80% of maximal voluntary contraction after consuming a placebo or 5 mg of folic acid. Brachial artery diameter and blood velocity were measured continuously using high-resolution ultrasound and analyzed using edge-detection software. Endothelial sensitivity to shear rate was quantified as the slope of the linear regression between brachial artery dilation (% change from baseline) and shear rate. Results: During the placebo visit, endothelial sensitivity to exercise-induced shear rate did not differ between females (0.102 ± 0.055 %/s-1) and males (0.091 ± 0.061 %/s-1, p=0.603). Acute folic acid consumption did not improve endothelial sensitivity to exercise-induced shear rate in females (placebo: 0.102 ± 0.055 %/s-1, folic acid: 0.099 ± 0.062 %/s-1, p=0.887) or males (placebo: 0.091 ± 0.061 %/s-1, folic acid: 0.102 ± 0.083 %/s-1, p=0.697). Conclusion: Endothelial sensitivity to exercise-induced shear rate does not differ between healthy postmenopausal females and age-matched males. Acute folic acid consumption does not improve endothelial sensitivity to exercise-induced shear rate in healthy older females or males.

This study aimed to evaluate the effects of short-term oral L-arginine (ARG) supplementation on vascular parameters, nitric oxide (NO) concentration, and muscular performance during upper limb resistance exercise in healthy young men. A randomized, double-blind, crossover design was used with 16 recreationally trained men. Participants ingested ARG (3.2-9.6g/day) or placebo for 4 days, separated by a 14-day washout. On the fourth day, they completed three sets of biceps curls at 65% of one-repetition maximum to concentric failure. Primary outcomes included total repetitions performed and fatigue ratio. Secondary outcomes comprised brachial artery diameter, peak systolic velocity, blood flow (velocity-time integral), vascular resistance index, plasma NO, and blood lactate concentrations. No significant differences were observed between ARG and placebo in muscular endurance (total repetitions, p = .305), volume load, or fatigue ratio. Plasma NO levels did not differ between conditions (p = .522). Although brachial artery diameter significantly increased 1-min postexercise in the ARG condition compared with placebo (p = .023), no differences were found for velocity-time integral, peak systolic velocity, resistance index, or blood pressure. Blood lactate concentrations rose after exercise in both groups, with a nonsignificant value in the ARG condition (p = .09 at 9-min postexercise). Short-term oral ARG supplementation did not enhance muscular endurance, systemic NO concentration, or vascular function during upper limb resistance exercise in healthy young men. Although a minor increase in brachial artery dilation was observed shortly after exercise, the effect was transient and insufficient to support meaningful ergogenic benefits.

Obtaining arterial access is one of the most technically challenging aspects of pediatric angiography and endovascular interventions. Due to anatomic and physiologic differences, pediatric arteries are small and prone to vasospasm and dissection. Together with the lack of dedicated pediatric-specific equipment, the risks for arterial occlusion and thrombotic complications are significantly higher in children: up to 16% in those who weigh less than 15 kg. Detailed preprocedural planning, including selection of an appropriate arterial access site, periprocedural optimization, use of US guidance for arterial puncture, and meticulous postaccess care can help improve the success rate and reduce adverse outcomes. Although the transfemoral approach remains the conventional access route for the majority of pediatric angiographic examinations and transarterial interventions, alternative access routes including umbilical, radial, brachial, or axillary arteries can be useful in certain clinical scenarios. In neonates, the umbilical vessels are the preferred access site, and their use may prevent access-related complications in the extremities. In steno-occlusive aortoiliac conditions or in complex interventions involving downward-sloping visceral arteries, upper extremity access (eg, radial, brachial, and axillary, depending on artery size) can aid in the delivery of interventional devices. Compared with traditional transfemoral access, transradial access also has the advantage of allowing early ambulation. Use of intraprocedural unfractionated heparin and vasodilators can help reduce vasospasm and thrombosis in small arteries. The mainstay of treatment of arterial thrombosis is systemic anticoagulation therapy, while catheter-directed thrombolysis or thrombectomy is reserved for patients with critical limb ischemia resistant to anticoagulation medication. ©RSNA, 2025 Supplemental material is available for this article.

Sitting time is high in older adults and has been shown to temporarily impair endothelial function and blood pressure (BP). Flavanols, plant-derived compounds, acutely enhance endothelial function and reduce BP in older adults. The aim of this study was to investigate whether acute ingestion of cocoa flavanols can improve peripheral endothelial function and BP during prolonged sitting in healthy older adults. In a randomised, double-blinded, within-subject, cross-over, placebo-controlled human study, 20 apparently healthy, older adults (age, 72.4 ± 5.0 years; 7 males, 13 females) consumed a high-flavanol (695 mg) and a low-flavanol (5.6 mg) cocoa beverage immediately before a 2-hour sitting bout. Flow-mediated dilation (FMD) of the superficial femoral (SFA; primary outcome) and brachial (BA) arteries, and BP, were assessed before and after sitting. Microvasculature haemodynamics were assessed in the gastrocnemius before, during, and after sitting. Sitting reduced both SFA FMD (Δ = -0.7%; p = 0.005) and BA FMD (Δ = -0.7%; p = 0.016) in the low-flavanol condition. The high-flavanol intervention prevented the decline in both SFA and BA FMD following sitting, with FMD measures remaining similar to pre-sitting (p > 0.3). Sitting increased both systolic (Δ = 6.1 mm Hg, p = 0.001) and diastolic BP (Δ = 2.6 mm Hg, p = 0.001), with no benefit from flavanol intake. Sitting increased muscle oxygenation resting levels (p < 0.001) and haemoglobin content (p < 0.001), and decreased muscle oxygen consumption during SFA occlusion (p < 0.001). Flavanols had no effect on the muscle microvasculature. These findings indicate that flavanol-rich foods may be efficacious nutritional strategies to counteract sitting-induced endothelial impairments during prolonged sitting in older adults, but do not alleviate sitting-induced increases in BP.

Shoulder dislocations are common in emergency settings; however, associated vascular injuries are rare, occurring in approximately 1–2% of cases. Among these, axillary and subclavian artery damage is particularly serious, with high morbidity and potential limb loss if not promptly recognized. We report the case of a 79-year-old male, hypertensive and dyslipidemic, who sustained a ground-level fall with right glenohumeral dislocation. Following an attempted closed reduction without sedation, he developed ischemic signs and an expanding hematoma. Initial workup with non-contrast tomography and bedside ultrasound suggested subclavian artery thrombosis. During brachial artery embolectomy, a complete subclavian artery rupture with a 7 cm gap was identified, requiring open repair with a 6 mm Dacron® graft. Postoperatively, the patient developed significant motor deficits of the right upper limb, confirmed by MRI and electromyography as brachial plexus injury. He was discharged on anticoagulation and remains under follow-up with partial functional recovery. This case highlights the importance of systematic neurovascular examination in shoulder dislocation, especially in elderly patients with comorbidities, as collateral circulation may mask early ischemia. Early use of contrast imaging and standardized emergency protocols are critical to improving outcomes. Although rare, subclavian artery injury during shoulder reduction must always be considered, requiring immediate diagnosis and intervention to preserve limb viability and function.

Cerebrovascular hemodynamics and cardiac biomarkers in multiple sclerosis: A case-control study.

Extremely delayed brachial artery pseudoaneurysm occurring 25 years after a severe burn injury: a case report and literature review

Background: Chronic kidney disease is a growing global health burden, with hemodialysis being the most widely used renal replacement therapy. Autologous arteriovenous fistula (AVF) remains the gold standard for vascular access, and pre-operative duplex sonography significantly improves maturation and long-term outcomes. Aims and Objectives: This study aimed to evaluate the role of Doppler ultrasound in arteriovenous access planning, fistula maturation time, and primary patency. Materials and Methods: This prospective study included 75 patients from the Barnard Institute of Radiology, Madras Medical College, and Rajiv Gandhi Government Hospital between March 2020 and August 2021. Patients underwent triplex Doppler ultrasound with a high-frequency linear probe to map the peripheral arteries and veins and assess their diameter, wall thickness, depth, and flow characteristics. Fistula planning prioritized forearm over upper-arm access, with post-operative evaluations at 4 and 6 weeks. Results: Hypertension was significantly more frequent in the radial group (P=0.03). Vessel assessment showed that the brachial arteries had a larger diameter (P=0.0005), higher peak systolic velocity (PSV) (P=0.0005), and greater flow (P=0.0005). The veins in the brachial group were larger (P=0.0005) and closer to the skin (P=0.001). Outcome analysis revealed that successful AVFs had significantly larger artery (2.5±0.58 vs. 1.5±0.33, P=0.0005) and vein diameters (2.9±0.54 vs. 1.8±0.46, P=0.0002), higher PSV (53.2±12.81 vs. 37.7±8.10, P=0.004), shallower depth (2.2±0.60 vs. 3.6±0.46, P=0.0001), and higher flow (592.9±61.30 vs. 159.3±23.11, P=0.0005). Conclusion: Triplex Doppler, which combines B-mode, color, and spectral imaging, is the preferred tool for AVF planning and follow-up. It enables the early detection of complications, reduces the risk of thrombosis, and improves survival.

Aim: This study evaluates the perceived educational value of four microanastomosis training models: the silicone tube model, the chicken wing brachial artery model, the UpSurgeOn Mycro simulator, and the Wistar Albino rat model, used within a structured microsurgical training program delivered during a national neurovascular symposium. Material and Methods: Sixteen participants completed a two-day, sixteen-hour microsurgical course that followed a stepwise training sequence. Pre-training and post-training surveys were administered for each modality using five-point Likert scales evaluating realism, technical difficulty, confidence, and overall suitability for microvascular skill development. Results: All modalities were perceived as educationally beneficial and contributed to microanastomosis skill development at different stages. The silicone tube model was viewed as highly effective for early-stage skill acquisition and basic instrument coordination. The chicken wing brachial artery model was appreciated for reproducing key biological characteristics while avoiding the logistical and ethical constraints. The Wistar Albino rat model was consistently rated as the most realistic and educationally valuable component of the training program, providing the closest approximation to operative conditions. The UpSurgeOn Mycro simulator did not meet participants expectations but served as a useful bridge between synthetic and biologic models. Conclusion: This multimodal stepwise approach to microanastomosis training was perceived as educationally valuable, with each model contributing at different stages of skill development. Based on these observations, incorporating structured simulation-based microanastomosis training into national neurosurgical education programs may help support preparedness for clinical practice.

Introduction: Arm amputations, caused primarily by trauma or vascular diseases, are often treated through complex replantation surgeries. This procedure involves challenges such as the presence of crush injuries, vascular and nerve damage, and the need for timely intervention to optimize functional recovery. Case Report: Our patient, 27-year-old male, presented with a traumatic left above-elbow amputation following a soil testing machine accident. Immediate surgical intervention was necessary, involving a multidisciplinary approach. The orthopedic team performed bone stabilization, while vascular and hand surgeons addressed complex soft tissue, vascular, and nerve injuries. The vascular team performed a reversed saphenous vein graft for the brachial artery, and nerve repairs were conducted under a microscope. The patient also underwent a subsequent procedure for fracture fixation and skin grafting. Conclusion: This report emphasizes the importance of early replantation, particularly in the presence of crush injuries, to restore function and minimize complications.

Reports in the literature suggest that the variations in branching patterns of the upper limb arteries and their prevalence may be influenced by sex and population affinity. A comprehensive investigation of branching patterns of the brachial artery and its branches is lacking in South Africans, with many reports focusing on the axillary artery. Therefore the current study aimed to record the incidence of the variations of the brachial, radial and ulnar arteries in a sample of the South African population. One hundred and eighty (180) upper limbs of 90 South African cadavers from the Department of Anatomy at Sefako Makgatho Health Sciences University were dissected. Normal anatomy according to standard anatomy textbooks and variant branching patterns of the brachial, radial and ulnar arteries were identified and recorded. SPSS software was used to establish the differences in variant branching patterns between side and sex. Upper limb arterial variations appeared in all the dissected cadavers. The recorded variations ranged from abnormal origin of the deep brachial artery, high division of the brachial artery into the ulnar and radial arteries, tortuous brachial and radial arteries, and superficial course of radial and ulnar arteries. The prevalence of brachial, ulnar and radial artery variations in the current study is comparable to that of previous studies. However, the superficial radial artery is more prevalent in males than in females in South Africans. The results of the current study provide crucial information for planning surgical procedures and interpretation of angiograms.

Phosphodiesterase type-5 inhibitors (PDE5is) are used for the treatment of erectile dysfunction (ED) and have potential cardioprotective effects. The impacts of PDE5is on cardiovascular parameters, which may be associated with the occurrence and progression of subclinical cardiovascular diseases, remain uncertain. In this study, we evaluated the effects of PDE5is on vascular parameters. Randomized controlled trials (RCTs) that compared the effects of PDE5is and placebo on vascular parameters and were published from 1998 to 2022 were identified from PubMed, Scopus and Web of Science. Mean differences (MDs) with 95% confidence intervals (CIs) were pooled. A sensitivity analysis was conducted to confirm the robustness of the pooled results. The keywords that were searched in the databasesare as follows: ((systolic blood pressure) OR (SBP) OR (diastolic blood pressure) OR (DBP) OR (mean arterial pressure) OR (MAP) OR (Pulse Wave Velocity) OR (PWV) OR (intima-media thickness) OR (cIMT) OR (augmentation Index) OR (AI) OR (FMD) OR (flow-mediated dilation) OR (reactive hyperemia index) OR (RHI) OR (Endothelial microparticles) OR (EMP) OR (EPCs) OR (Endothelial Progenitor Cells) OR (PSV) OR (peak systolic velocity)) AND ((PDE5 Inhibitors) OR (PDE5i) OR (Sildenafil) OR (Vardenafil) OR (Tadalafil) OR (Lodenafil) OR (Udenafil) OR (Avanafil)). Sixty-three studies involving 3242 subjects were included. Overall, PDE5is decreased systolic blood pressure (MD: -2.80mmHg, 95% CI: -4.24, -1.37, P < 0.001), diastolic blood pressure (MD: -1.80mmHg, 95% CI: -2.37, -1.22, P < 0.001), carotid intima‒media thickness (MD: -0.01mm, 95% CI: -0.02, -0.01, P < 0.001), and pulse wave velocity (MD: -0.75cm/s, 95% CI: -1.01, -0.49, P < 0.001). In addition, PDE5is increased the peak systolic velocity (MD: 3.70cm/s, 95% CI: 3.52, 3.88, P < 0.001), flow-mediated dilation (MD: 2.47%, 95% CI: 1.24, 3.71, P < 0.001), concentration of endothelial progenitor cells (MD: 475.29 cells/mL, 95% CI: 51.38, 899.20, P = 0.03), and concentration of endothelial microparticles (MD: 4.86%, 95% CI: 0.65, 9.07, P = 0.02). However, the effects of PDE5is on the augmentation index, brachial artery diameter and reactive hyperemia index were not statistically significant. Compared with the placebo, PDE5is improved vascular parameters, indicating the potential of PDE5is for treating subclinical cardiovascular diseases. Further research is needed to confirm the role of the improvement on vascular parameters by PDE5isin preventing and treating cardiovascular diseases. The present study protocol was reviewed and approved by PROSPERO. The title is "Associations between PDE5is and vascular parameters: A systematic review and meta-analysis" (https://www.crd.york.ac.uk/PROSPERO/) (Reg. No. CRD42023387924).

The brachial artery is the most commonly injured artery in the upper extremities because of its vulnerability. This case report presents our experience with managing brachial artery injury using an improvised vascular shunting technique. A 38-year-old man presented to the emergency department with a penetrating bullet wound on the forearm, resulting in a 10cm transection of the brachial artery, brachial vein injury, and small medial epicondyle fracture. Emergency surgery was performed following resuscitation. Intraoperatively, a temporary vascular shunt was created using an intravenous drip to maintain distal perfusion before definitive repair. The brachial artery was reconstructed using a graft from the great saphenous vein harvested from the thigh. The brachial vein was ligated and two K-wires were used to stabilize the medial epicondyle fragment. Postoperatively, the patient showed good recovery, with proper wound healing, intact hand sensation, and distal blood supply, and was discharged after two weeks.

Abstract.

BackgroundEndothelial dysfunction (ED) is an early marker of cardiovascular disease (CVD), influenced by both physiological and psychosocial factors. While depression and anxiety are known contributors to ED, the role of spiritual well-being (SWB) in vascular health has been relatively less explored in the literature.ObjectiveTo investigate the association between SWB and ED in clinically healthy adults, controlling for mental health variables and conventional cardiovascular risk factors.MethodsIn this cross-sectional study, 148 individuals aged 18–60 years were assessed using validated instruments: FACIT-Sp for SWB, PHQ-9 for depression, GAD-7 for anxiety, and brachial artery flow-mediated dilation (FMD) for endothelial function. Logistic regression and discriminant analyses were performed to identify independent predictors of ED and the spiritual dimensions most associated with vascular health.ResultsED was identified in 39.2% of participants. Multivariate logistic regression indicated that SWB (OR = 0.929; p = 0.005), body mass index (OR = 1.130; p = 0.016), generalized anxiety disorder (OR = 2.551; p = 0.035), and major depressive episode (OR = 3.740; p = 0.038), were significantly associated with ED. Among these, SWB was significantly inversely associated with ED even after excluding participants with anxiety or depression. Discriminant analysis further indicated that inner peace and life purpose—but not faith—significantly distinguished individuals with and without ED.ConclusionSWB, particularly dimensions related to inner peace and meaning, is independently associated with preserved endothelial function in healthy adults. These findings support the inclusion of psychosocial and spiritual dimensions in cardiovascular risk assessment and prevention strategies.