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Purpose: To evaluate the technical success and complication rates of vascular closure devices (VCDs) in the axillary artery. Materials and Methods: MEDLINE and Embase were searched independently by two reviewers to identify observational studies from inception through October 2021. The following outcomes were meta-analyzed: technical success, hematoma, dissection, pseudoaneurysm, infection, and local neurological complications. Complications were also graded as mild, moderate, and severe. A logistic regression evaluating the influence of sheath size for the outcome of technical success rate was performed using individual patient–level data. Results: Of 1496 unique records, 20 observational studies were included, totaling 915 unique arterial access sites. Pooled estimates were as follows: technical success 84.8% (95% confidence interval [CI]: 78%–89.7%, I2=60.4%), hematoma 7.9% (95% CI: 5.8%–10.6%, I2=0%), dissection 3.1% (95% CI: 1.3%–7.3%, I2=0%), pseudoaneurysm 2.7% (95% CI: 1.3%–5.7%, I2=0%), infection <1% (95% CI: 0%–5.7%, I2=20.5%), and local neurological complications 2.7% (95% CI: 1.7%–4.4%, I2=0%). There was a significant negative association between sheath size and technical success rate (odds ratio [OR]: 0.87 per 1 French (Fr) increase in sheath size, 95% CI: 0.80–0.94, p=0.0005). Larger sheath sizes were associated with a greater number of access-site complications (adjusted odds ratio [aOR]: 1.21 per 1 Fr increase sheath size, 95% CI: 1.04–1.40, p=0.013). Conclusions: Off-label use of VCDs in the axillary artery provides an 85% successful closure rate and variable complication rate, depending on the primary procedure and sheath size. Larger sheaths were associated with a lower technical success and greater rate of access-related complications. Clinical Impact: Safe arterial access is the foundation for arterial intervention. While the common femoral artery is a well established access site, alternative arterial access sites capable of larger sheath sizes are needed in the modern endovascular era. This article provides the largest synthesis to date on the use of vascular closure devices for percutaneous axillary artery access in endovascular intervention. It should serve clinicians with added confidence around this approach in terms of providing a reference for technical success and complications. Clinically, this data is relevant for patient consent purposes as well as for practice quality improvement in setting safety standards for this access site. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The Impella 5.5® is commonly inserted via the axillary artery (AX) in patients with cardiogenic shock. The right AX has traditionally been preferred to avoid crossing the aortic arch, and a minimum diameter of 7 mm has been recommended to accommodate the device (21 Fr). There is limited data on choice of laterality of access and AX size required, both in terms of technicality of the procedure as well as outcomes.We performed a single‐center retrospective cohort analysis of patients who underwent Impella 5.5® implantation between December 2020 and February 2024 (N = 75). Data including demographics and outcomes were stratified both by diameter (small, <7 mm vs. normal, ≥7 mm) and laterality of access (right vs. left). Adverse events included stroke, limb ischemia, procedural bleeding or infection, and unplanned explant due to complications. Delivery time was defined as time from advancing the first wire to activation of the device.AX approach was attempted in all (N = 74) but one requiring innominate access, with a technical success rate of 95.9% (N = 71/74). The mean age was 58.8 ± 13.3 years, with 81.1% males. The median delivery time was 7.0 (25th, 75th percentiles: 4.0, 11.5) min with a median support duration of 13 (7.7, 24) days. Ten patients (13.5%) had a small AX, with a mean diameter of 6.3 ± 0.5 mm and were more likely to be younger compared to the normal AX group. Fifty‐nine patients (79.7%) had insertion via the right AX. Median delivery time was comparable across all groups (small, 5.4 [3.5, 10.9] vs. normal, 7 [4.0, 12.1] min, p = 0.59) and (right, 10.4 [5.3, 15.2] vs. left, 6 [3.7, 10.4] min, p = 0.35). There was no difference between the rates of stroke, ischemia, bleeding, or infection when comparing by size or laterality. Survival to discharge was 59.5%, with 21.1% mortality on support, all in patients with a normal AX diameter, but with no difference between right versus left.In our study, laterality and a small diameter of AX access did not affect outcomes of Impella 5.5®, with a similar safety profile. [ABSTRACT FROM AUTHOR]

Objectives: Acknowledging lacking of consensus exist in total aortic arch (TAA) surgery for acute type A aortic dissection (AAD), this study aimed to investigate the neurologic injury rate between bilateral and unilateral cerebrum perfusion on the specific population. Methods: A total of 595 AAD patients other than Marfan syndrome receiving TAA surgery since March 2013 to March 2022 were included. Among them, 276 received unilateral cerebral perfusion (via right axillary artery, RCP) and 319 for bilateral cerebral perfusion (BCP). The primary outcome was neurologic injury rate. Secondary outcomes were 30-day mortality, serum inflammation response (high sensitivity C reaction protein, hs-CRP; Interleukin-6, IL-6; cold-inducible RNA binding protein, CIRBP) and neuroprotection (RNA-binding motif 3, RBM3) indexes. Results: The BCP group reported a significantly lower permanent neurologic deficits [odds ratio: 0.481, Confidence interval (CI): 0.296–0.782, p = 0.003] and 30-day mortality (odds ratio: 0.353, CI: 0.194–0.640, p < 0.001) than those received RCP treatment. There were also lower inflammation cytokines (hr-CRP: 114 ± 17 vs. 101 ± 16 mg/L; IL-6: 130 [103,170] vs. 81 [69,99] pg/ml; CIRBP: 1076 [889, 1296] vs. 854 [774, 991] pg/ml, all p < 0.001), but a higher neuroprotective cytokine (RBM3: 4381 ± 1362 vs 2445 ± 1008 pg/mL, p < 0.001) at 24 h after procedure in BCP group. Meanwhile, BCP resulted in a significantly lower Acute Physiology, Age and Chronic Health Evaluation (APACHE) Ⅱscore (18 ± 6 vs 17 ± 6, p < 0.001) and short stay in intensive care unit (4 [3,5] vs. 3 [2,3] days, p < 0.001) and hospital (16 ± 4 vs 14 ± 3 days, p < 0.001). Conclusions: This present study indicated that BCP compared with RCP was associated with lower permanent neurologic deficits and 30-day mortality in AAD patients other than Marfan syndrome receiving TAA surgery. [ABSTRACT FROM AUTHOR]

Background: Arterial catheter placement for hemodynamic monitoring is commonly performed in critically ill patients. The radial and femoral arteries are the two sites most frequently used; there is limited data on the use of the axillary artery for this purpose. The aim of this study was to investigate the rate of complications from ultrasound-guided axillary artery catheter placement in critically ill patients. Methods: A retrospective study at a tertiary care center of patients admitted to an intensive care unit who had ultrasound-guided axillary artery catheter placement during admission. Primary outcome of interest was catheter related complications, including bleeding, vascular complications, compartment syndrome, stroke or air embolism, catheter malfunction, and need for surgical intervention. Results: This study identified 88 patients who had an ultrasound-guided axillary artery catheter placed during their admission. Of these 88, nine patients required multiple catheters placed, for a total of 99 axillary artery catheter placement events. The median age was 64 [IQR 48, 71], 41 (47%) were female, and median body mass index (BMI) was 26 [IQR 22, 30]. The most common complication was minor bleeding (11%), followed by catheter malfunction (2%), and vascular complications (2%). Univariate analyses did not show any association between demographics and clinical variables, and complications related to axillary arterial catheter. Conclusion: The most common complication found with ultrasound-guided axillary artery catheter placement was minor bleeding, followed by catheter malfunction, and vascular complications. Ultrasound-guided axillary arterial catheters are an alternative in patients in whom radial or femoral arterial access is difficult or not possible to achieve. [ABSTRACT FROM AUTHOR]

Cannulation strategies in aortic arch surgeries are a matter of immense discussion. Majority of time deep hypothermic circulatory arrest (DHCA) is the way out, but it does come with its set of demerits. Here we demonstrate a case with aortic arch dissection dealt with dual cannulation strategy in axillary and femoral artery without need for DHCA and ensuring complete neuroprotection of brain and spinal cord without hinderance of time factor. Inception of new ideas like this may decrease the need for DHCA and hence its drawbacks, thus decreasing the morbidity and mortality associated. [ABSTRACT FROM AUTHOR]

This document describes a case study presented at a medical conference about a preterm neonate with a congenital hepatic hemangioma (CHH). The neonate had right heart failure and pulmonary hypertension, as well as a patent ductus arteriosus (PDA) and atrial septal defect (ASD). Due to the neonate's small femoral arteries and bleeding diathesis, a trans-umbilical venous approach was used to access the arterial system via the PDA. The embolization procedure was successful, and the neonate's condition improved in the following weeks. This approach offers an alternative for neonates with difficult arterial access and coagulopathy. [Extracted from the article]

Objective: Traumatic axillary and subclavian artery injuries are uncommon. Limited data are available regarding patient and injury characteristics, as well as management strategies and outcomes. Methods: Retrospective chart review was performed on patients presenting to University of Louisville Hospital, an urban Level One Trauma Center, with traumatic axillary and subclavian artery injuries from 2015-2021. Patients were identified using University of Louisville trauma, radiology, and billing database searches based on ICD9/10 codes for axillary and subclavian artery injuries. Descriptive statistics are expressed as frequencies and percentages. Comparisons were performed using Fisher's Exact and Chi-squared tests. Results: Forty-four patients with traumatic axillary-subclavian arterial injuries were identified for analysis. Blunt and penetrating trauma were equally represented (n = 22 for both). A variety of injury types were seen, including minimal/intimal injury, laceration, pseudoaneurysm, transection, occlusion, and arteriovenous fistula. Management strategies were also variable, including non-operative, endovascular, planned hybrid, open, and endovascular converted to open. In operative patients, revascularization technical success was high (n = 31, 97%) with low likelihood of thrombosis (n = 2, 6%) and no infections. Among all patients, amputation rate was 5% (n = 2) and mortality rate was 9% (n = 3). Regarding arterial involvement, blunt injury was more likely to affect the subclavian (n = 18) than the axillary artery (n = 6) (P =.04). No significant difference was seen in brachial plexus injury based on artery involved (subclavian = 9 vs axillary = 11, P =.14) or mechanism (blunt = 6 vs penetrating = 11, P =.22). Non-operative management was more likely with subclavian artery injury (n = 11) vs axillary artery injury (n = 1) (P =.008). There was no significant difference between decision for non-operative (blunt = 9, penetrating = 3) vs operative (blunt = 13, penetrating = 19) management based on mechanism (P =.09). Transection injury was associated with an open repair strategy (endovascular/hybrid = 1, open/endovascular to open conversion = 11, P =.0003). Of the three patients requiring endovascular to open conversion, two required amputation, which were the only two patients in the study undergoing amputation. Conclusions: Both open and endovascular/hybrid strategies are useful when treating traumatic axillary and subclavian artery injuries and are associated with high likelihood of revascularization technical success, with low rates of thrombosis or infection, when treated promptly at a trauma center with vascular specialists available. Transection injuries were most often treated with open revascularization. Patients undergoing amputation had blunt transection injuries to the subclavian artery and underwent endovascular to open conversion after failed attempts at endovascular revascularization. [ABSTRACT FROM AUTHOR]

This article examines the thickness of certain arteries in patients with polymyalgia rheumatica (PMR) compared to a control group. The study found that PMR patients tended to have a larger thickness in the common carotid artery, but no difference in the axillary artery or subclavian artery. The study also identified several factors that can affect artery thickness, such as arterial diameter, hypertension, smoking, diabetes, history of cerebrovascular events, and age. The authors suggest considering these factors when using artery thickness as a diagnostic tool for PMR and giant cell arteritis. [Extracted from the article]

This article discusses a case of giant cell arteritis (GCA) with genital system involvement. GCA is a chronic inflammatory condition that primarily affects individuals over the age of 50. While GCA commonly affects the temporal arteries, it can also involve other arteries, including those in the lung, breast, and gynecological system. The article presents a case of a 61-year-old female patient who was diagnosed with GCA based on the analysis of ovarian and uterine pathology specimens. The patient's symptoms and acute phase reactants returned to normal with treatment, and her progress has been monitored for 3 years. The article emphasizes the importance of considering GCA in patients with systemic inflammatory symptoms and genital system problems. [Extracted from the article]

Background: It is aimed to compare the block onset times and performance features of costoclavicular techniques (medial and lateral approach) versus lateral sagittal technique. Methods: Patients were randomized into three groups. For costoclavicular techniques, ultrasound probe was placed parallel to clavicle obtaining nerve cords, axillary artery and axillary vein visual from lateral-to-medial, respectively. The block needle was advanced from lateral (Group CLB) or medial (Group CMB) to perform costoclavicular block. For lateral sagittal technique (Group LSB), ultrasound probe was placed sagittal and perpendicular below the coracoid process to obtain sagittal artery image with the cords around. Total 20 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine were deposited for all groups. Sensory and motor block onset times, block performance properties, complications, and patient/surgeon satisfactions were investigated. Results: Among 56 patients, the primary outcome, sensory block onset time was shorter in Group CLB than Group CMB and Group LSB (10 [5–15], 10 [10–20], and 15 [10–15] minutes, respectively, p < 0.05). Motor block onset was also fastest in Group CLB (15 [10–20] mins for CLB, 20 [15–20] mins for LSB, and 22.5 [15–25] mins for CMB, p = 0.004). Block performance properties did not differ between the groups. The only complication observed was vascular puncture with an incidence of 28% in Group CMB. Conclusions: Lateral approach costoclavicular technique provides fastest block onset than the other techniques. Considering the success and safety profile, this technique stands as a good alternative in clinical practice. Trial registration: This study is prospectively registered to clinicaltrials.gov on 20/02/2022 (NCT05260736). [ABSTRACT FROM AUTHOR]

Case: (1) A 69-year-old man sustained a proximal humeral fracture-dislocation. During emergency surgery, copious bleeding occurred. A pseudoaneurysm was identified 30 days postoperatively. (2) A 69-year-old man sustained a proximal humeral fracture and axillary artery injury. Physical examination demonstrated a cold but pink hand. Hemiarthroplasty and bypass vein grafting were performed. (3) An 86-year-old woman sustained a proximal humeral fracture and axillary artery injury. Her hand had turned cold and pale. Reverse shoulder arthroplasty and bypass vein grafting were performed. Conclusion: In cases of proximal humeral fractures with significant displacement, concomitant axillary artery injury must be assessed and if there is a high index of suspicion, prompt advanced imaging is necessary. [ABSTRACT FROM AUTHOR]

The axillary artery is a continuation of the subclavian artery and transitions into the brachial artery. Variations in the axillary artery are not uncommon. During the upper-limb dissection of a 95-year-old Korean female cadaver, assorted anatomical variations of the axillary artery branches were identified. On the right side, no branches emerged from the first part of the axillary artery. The thoracoacromial artery (excluding the pectoral branch) and the common subscapular trunk arose from the second part, with the common subscapular trunk giving origins to the pectoral branch, lateral thoracic artery, and subscapular artery. The subscapular artery is divided into the thoracodorsal artery, circumflex scapular artery, and accessory posterior circumflex humeral artery. Additionally, the superior thoracic artery arose from the lateral thoracic artery. The third part of the axillary artery gave rise to the anterior and posterior circumflex humeral arteries, accessory acromial branch, and accessory thoracodorsal artery. On the left side, the thoracoacromial artery (excluding the pectoral branch) and the superior thoracic artery arose from the first part. The common subscapular trunk arose from the second part, which included the pectoral branch, lateral thoracic artery, and subscapular artery. The subscapular artery is divided into the thoracodorsal artery, circumflex scapular artery, accessory posterior circumflex humeral artery, and accessory lateral thoracic artery. The third part gave rise to the anterior and posterior circumflex humeral arteries and the accessory acromial branch. This study presents variations of the axillary artery, emphasizing their rarity, considering their embryologic basis, and highlighting their importance not only for educational purposes but also surgical and radiological applications. [ABSTRACT FROM AUTHOR]

Background: The axillary artery (AX) access for intra‐aortic balloon pump (IABP) as a bridge to heart transplant (HT) allows mobility while awaiting a suitable donor. As end‐stage heart failure patients often have an implantable cardioverter defibrillator (ICD) on the left side, the left AX approach may be avoided due to the perception of difficult access and proximity of two devices. We aimed to evaluate the outcomes of patients bridged to HT with a left‐sided AX IABP with or without ipsilateral ICDs. Methods: We retrospectively reviewed HT candidates at our institution supported by left‐sided axillary IABP from November 2019 to February 2024, dividing them into two groups based on the presence (Group ICD, n = 48) or absence (Group No‐ICD, N = 19) of an ipsilateral left‐sided ICD. The exposure time was defined as the time from skin incision to the beginning of anastomoses of a Dacron graft. Results: Technical success was achieved in 100% of the cohort, with median exposure times for AX access similar between groups (ICD, 12 [7.8, 18.2] vs. No ICD, 11 [7, 19] min; p = 0.75). The rate of procedural adverse events, such as significant access site bleeding and ipsilateral limb ischemia, did not significantly differ between both groups. Device malfunction rates were comparable (ICD, 29.2% vs. No ICD, 15.8%; p = 0.35). Posttransplant, in‐hospital mortality, severe primary graft dysfunction, and stroke rates were comparable in both groups. Conclusion: The presence of an ipsilateral left‐sided ICD does not adversely impact the procedural efficacy, complication rates, or posttransplant outcomes of left‐sided AX IABP insertion in HT candidates. [ABSTRACT FROM AUTHOR]

Background: The benefits and harms associated with femoral artery cannulation over other sites of arterial cannulation for surgical repair of acute Stanford type A aortic dissection (TAAD) are not conclusively established. Methods: We evaluated the outcomes after surgery for TAAD using femoral artery cannulation, supra‐aortic arterial cannulation (i.e., innominate/subclavian/axillary artery cannulation), and direct aortic cannulation. Results: 3751 (96.1%) patients were eligible for this analysis. In‐hospital mortality using supra‐aortic arterial cannulation was comparable to femoral artery cannulation (17.8% vs. 18.4%; adjusted OR 0.846, 95% CI 0.799–1.202). This finding was confirmed in 1028 propensity score‐matched pairs of patients with supra‐aortic arterial cannulation or femoral artery cannulation (17.5% vs. 17.0%, p = 0.770). In‐hospital mortality after direct aortic cannulation was lower compared to femoral artery cannulation (14.0% vs. 18.4%, adjusted OR 0.703, 95% CI 0.529–0.934). Among 583 propensity score‐matched pairs of patients, direct aortic cannulation was associated with lower rates of in‐hospital mortality (13.4% vs. 19.6%, p = 0.004) compared to femoral artery cannulation. Switching of the primary site of arterial cannulation was associated with increased rate of in‐hospital mortality (36.5% vs. 17.0%; adjusted OR 2.730, 95% CI 1.564–4.765). Ten‐year mortality was similar in the study cohorts. Conclusions: In this study, the outcomes of surgery for TAAD using femoral arterial cannulation were comparable to those using supra‐aortic arterial cannulation. However, femoral arterial cannulation was associated with higher in‐hospital mortality than direct aortic cannulation. Trial registration: ClinicalTrials.gov registration code: NCT04831073. [ABSTRACT FROM AUTHOR]

Debranching thoracic endovascular aortic repair may disturb the implantation of a cardiac implantable electronic device in the anterior thoracic region. In case 1, the bypass graft between the right axillary artery, left axillary artery, and left common carotid artery disturbed pacemaker implantation from the left anterior thoracic region. Therefore, right‐sided implantation was selected. By contrast, in case 2, the bypass graft between axillary arteries in the anterior thoracic region was visible on fluoroscopy, and we performed conventional left‐sided pacemaker implantation with extra‐thoracic puncture. The pacemaker implantations were successful in both cases. The implantation strategies were affected by the number of debranched arteries and visibility of the bypass graft. [ABSTRACT FROM AUTHOR]

Background Surgically implanted Impella 5.5. delivers full cardiac support and left ventricular unloading for patients with heart failure. So far, the Impella device is implanted under general anesthesia (GA). Material and Methods A total of n = 3 critically ill patients presented with acute heart failure in need of cardiac support. All patients suffered cardiogenic shock of varying etiology. Due to hemodynamically unstable conditions, GA was avoided. All implantations were performed solely under local anesthesia (LAS) without any regional anesthesia. Results All implantations were performed successfully under LAS with 60 mL of mepivacaine of 2% solution and ropivacaine of 1% solution (50:50 ratio). All devices were placed from the right axillary artery. One patient needed hematoma evacuation several days after surgery. No other Impella-related complication was observed. Conclusion A surgical implantation of the Impella 5.5 device under LAS is feasible and safe. Despite the small number of cases, no disadvantage can be described at the present moment. Our series should encourage physicians to perform the procedure under LAS. [ABSTRACT FROM AUTHOR]

It has been proposed that formation of abdominal aortic aneurysm (AAA) is part of a systemic arterial dilatative disease. However, arteries in the upper extremities are scarcely studied and it remains unclear whether both muscular and elastic arteries are affected by the proposed systemic arterial dilatation. The aim of this study was to investigate the diameter and stiffness of muscular and elastic arteries in arterial branches originating from the aortic arch. Twenty-six men with AAA (69 ± 4 yr) and 57 men without AAA (70 ± 5 yr) were included in the study. Ultrasound was used to examine the distal and proximal brachial artery, axillary artery, and common carotid artery (CCA), and measurement of diameter and diameter change was performed with wall-tracking software. Blood pressure measurements were used to calculate local arterial wall stiffness indices. The AAA cohort presented larger arterial diameters in the CCA and axillary artery after adjustment for body surface area (P = 0.002, respectively), whereas the brachial artery diameters were unchanged. Indices of increased stiffness in CCA (e.g., lower distensibility, P = 0.003) were seen in subjects with AAA after adjustments for body mass index and mean arterial blood pressure. This study supports the theory of a systemic arterial dilating diathesis in peripheral elastic, but not in muscular, arteries. Peripheral elastic arteries also exhibited increased stiffness, in analogy with findings in the aorta in AAA. NEW & NOTEWORTHY: We present data partially supporting the notion of abdominal aortic aneurysm being a systemic vascular disease with focal manifestation in the abdominal aorta, from two well-defined groups recruited from a regional screening program. We show that elastic arteries distal from the aorta exhibit vascular alterations without aneurysmal formation in subjects with AAA compared with controls while muscular arteries seem unaffected. [ABSTRACT FROM AUTHOR]

The article discusses research which focused on non-specific symptoms pathway (NSSP) programmes and the diagnosis of large vessel giant cell arteritis (LV-GCA). Topics explored include the use of the NSSP programme by primary care physicians in making referrals for patients with possible malignancy, the common clinical manifestations of LV-GCA, and the diagnostic accuracy of computed tomography (CT) imaging in identifying LV-GCA.

Abstract In the left axilla of a formalin-embalmed adult female cross-breed dog, an unusual course of the axillary artery in relation to the brachial plexus was noted. A part of the axillary artery after the origin of the subscapular artery coursed through the loop formed by the contributions of the caudal pectoral and lateral thoracic nerves and then between the median and ulnar nerves. Thus, the common trunk for the latter two nerves was missing. Instead, in the proximal brachium, they communicated with each other in both directions. A communicating branch between the cranial and caudal pectoral nerves forming a nerve loop, ansa pectoralis lacked the axillary artery and was instead traversed by the subscapular artery. This is a variation in the relationship between the axillary artery and brachial plexus in the domestic dog and has not been reported in the literature yet. The axillary artery entrapped by the contributions of the caudal and lateral thoracic nerves may be considered as a risk factor for the neuroarterial compressions with non-specific signs and should be taken into account both in surgery and imaging.

Background: Ultrasound (US)-guided costoclavicular block (CCB) is a promising new approach to brachial plexus (BP) block which is increasingly being utilized. Conventionally, the costoclavicular space (CCS) has been described to contain three cords. However, there may be variations in the neural pattern of the BP which is important to know to prevent inadvertent injury. We intend to describe the variations in neural patterns from retrospective scans of patients receiving costoclavicular BP block. Methods: The stored US images of patients who had received BP block using the CCB for surgery at the level of the elbow or below in the last year (from March 2021 to March 2022) were analyzed by two investigators independently. The clinical data were retrieved from the records of the same patients for the study outcomes. We collated the variations of the neural pattern, the number of neural structures seen, and the echogenicity of the structures in the costoclavicular BP space. Results: In the CCS, the median number of neural structures was 4.5 (minimum of 3 to maximum of 8). With the BP lateral to the axillary artery and sandwiched between the subclavius-pectoralis minor superiorly and the serratus anteriorly inferiorly, numerous variations in the neural structures were noted. The most common arrangement was caterpillar-like (28.6%) and pecker-like (20.3%). The neural structures were found to be hypoechoic in the majority (66%). Conclusion: The CCS hosts several mostly hypoechoic neural structures which may be the variations of the cords or the extension of BP divisions. These new findings have been unreported in the recent past.

Abstract Background Stent-graft placement is generally used to treat pseudoaneurysm (PSA) of the axillary artery (AA) trunk to maintain the patency of peripheral vessels. Coil embolization of a PSA associated with a disrupted AA trunk has rarely been reported. Case presentation A 54-year-old woman presented with swelling of her right shoulder. She had had a right proximal humeral fracture 12 years earlier. Contrast-enhanced computed tomography (CECT) and subsequent angiograms revealed a giant PSA at the disrupted, distal right AA. There were collateral flows to the brachial artery from the proximal to the right AA. To preserve collateral flows to the brachial artery, selective embolization of the inflow artery that derived from the distal AA was performed with hydrogel-coated coils. The post-embolization arteriogram showed no flow into the PSA, but collateral flows to the brachial artery we preserved. The post-embolization course was uneventful. The patient regained warmth in her right arm and hand on post-embolization day 4. Repeat CECT on post-embolization day 9 confirmed blood-flow to her right radial artery. Conclusions While a stent-graft should be used if the AA trunk can be preserved, coil embolization should be considered for PSA if the AA trunk is disrupted but collaterals are preserved.

In the left axilla of a formalin-embalmed adult female cross-breed dog, an unusual course of the axillary artery in relation to the brachial plexus was noted. A part of the axillary artery after the origin of the subscapular artery coursed through the loop formed by the contributions of the caudal pectoral and lateral thoracic nerves and then between the median and ulnar nerves. Thus, the common trunk for the latter two nerves was missing. Instead, in the proximal brachium, they communicated with each other in both directions. A communicating branch between the cranial and caudal pectoral nerves forming a nerve loop, ansa pectoralis lacked the axillary artery and was instead traversed by the subscapular artery. This is a variation in the relationship between the axillary artery and brachial plexus in the domestic dog and has not been reported in the literature yet. The axillary artery entrapped by the contributions of the caudal and lateral thoracic nerves may be considered as a risk factor for the neuroarterial compressions with non-specific signs and should be taken into account both in surgery and imaging. [ABSTRACT FROM AUTHOR]

This work extensively studied the vasculature of mice mammary fat pads (BALB/c and C57BL/6) with special reference to haematogenous drainage routes. Mammary fat pads were five pairs (first cervical, second and third thoracic, fourth abdominal and fifth inguinal), bilaterally symmetrical, extending laterally and continuously with the subcutaneous fascia. The superficial cervical artery and vein primarily accomplished the blood vasculature of the first mammary fat pad, while the lateral thoracic and external thoracic arteries and veins supplied the second and third mammary fat pads. The superficial cervical vein (found parallel to the superficial cervical artery) drained into the external jugular vein. The lateral thoracic artery and external thoracic artery branched almost at the same level as the axillary artery (branch of subclavian artery), the latter being more medial in position. However, in some specimens, the branching of both arteries appeared to be at the same level, and their origins were indistinguishable. The lateral thoracic vein that was parallel to the lateral thoracic artery drained to the axillary vein close to the drainage of the external thoracic vein. The lateral thoracic, superficial caudal epigastric, iliolumbar and external thoracic arteries and veins vascularized the fourth mammary fat pad and displayed anastomosis among themselves. The iliolumbar vein (found parallel to the iliolumbar artery) drained into the inferior vena cava. The superficial caudal epigastric vein (found parallel to the superficial caudal epigastric artery (SCaEA)) drained into the femoral vein. Unlike humans, the internal thoracic artery and vein did not participate in the vasculature of mammary fat pads. The SCaEA and vein supplied blood and drained the fifth mammary fat pad. The anatomical continuity of the fourth and fifth mammary fat pads provided common drainage for both mammary fat pads. The BALB/c and C57BL/6 mice strains studied did not differ in topography and size of mammary fat pads. The vascular supply and drainage of the mammary fat pads also did not differ in the strains studied. Only minor variations could be noted in the small veins draining into the lateral thoracic vein. Lateral tributaries seen in the terminal end of the lateral thoracic vein were absent in the C57BL/6 mice. [ABSTRACT FROM AUTHOR]

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Introduction: Proximal humerus fractures (PHF) are common injuries that can lead to axillary artery injury, which carries the risk of not being identified during initial assessment. The aim of this study was to describe the management of suspected axillary artery injury associated with PHF according to our experience and to describe a new multidisciplinary surgical approach. Methods: This was a single-center retrospective study. A database was created for patients admitted for PHF to the emergency department of the Hospital of Cannes between October 2017 and October 2019. Patients admitted with PHF associated with suspected ipsilateral upper limb ischemia, and/or massive diaphysis displacement, and/or upper limb ipsilateral neurological deficits were included in this study. Results: In total, 301 patients diagnosed with PHF were admitted within these periods. Among these patients, 12 presented with suspected axillary artery lesions, of whom, 6 were included in the present study and treated according to our new approach. A description of these 6 cases, along with an extensive literature review is presented. Conclusion: Based on our experience, the endovascular approach proposed for the management of axillary artery injury associated with proximal humerus fractures is effective, feasible and reproducible. [ABSTRACT FROM AUTHOR]

Variability in the topography of the arteries of the upper extremity is associated with fetal development. Determination of individual anatomical variants of the upper extremity blood supply at different stages of ontogeny, especially in human fetuses, is of great practical importance in vascular surgery. Aim of the study. To study the individual anatomical variability of the ulnar and radial arteries in human fetuses of different ages. Material and methods. The study of variants of the topography of the branches of the radial and ulnar arteries, the peculiarities of the formation of the superficial palmar arterial arch was carried out on 46 preparations of the upper extremities of 23 human fetuses 81. 0-375, 0 mm parieto-coccygeal length using macromicroscopic dissection, vascular injection and morphometry without external signs of anatomical abnormalities or congenital malformations of skeletal, fascial-muscular and vascular-nerve structures of the upper extremities. Results and discussion. Our study demonstrated fetal anatomical variability and bilateral asymmetry of the right and left upper extremity arteries in human fetuses. Thus, in a fetus with a PCL of 210.0 mm, the right brachiocephalic artery was found to originate from the right axillary artery. It should be noted that the initial portion of the right brachiocephalic artery passed anteriorly, not posteriorly, to the median nerve, and at the level of the middle third of the anterior shoulder region, the artery occupied a superficial position relative to the median nerve, which is located in the lateral bicuspid groove of the shoulder. The brachiocephalic artery was then directed in an oblique lateral direction to the lateral surface of the forearm. In this fetus, a high origin of the right ulnar artery was found, which originated from the trunk of the brachiocephalic artery in the upper third of the right anterior shoulder region. At the border of the middle and lower thirds of the anterior shoulder region, the ulnar artery crossed the ulnar nerve anteriorly and passed with it in the median biceps groove of the shoulder. 3.0 mm below the beginning of the ulnar artery, the superior circumflex ulnar artery bifurcated from the brachiocephalic artery, and in the lower third of the anterior shoulder region, a common trunk bifurcated from the brachiocephalic artery and bifurcated into the middle and inferior circumflex ulnar arteries. We found arterial anastomoses between the latter and branches of the ulnar artery. The immediate continuation of the right brachiocephalic artery in the palm was the brachiocephalic artery of the thumb. At the level of the base of the proximal phalanx of the thumb, the brachiocephalic artery branched into three palmar finger arteries, which were directed to both edges of the palmar surface of the first finger and the radial edge of the palmar surface of the second finger. The superficial palmar arch was formed by the superficial palmar branch of the brachial radial artery, the terminal ulnar artery, and the anterior interosseous artery. Four common palmar arteries originated from the superficial palmar arch and were directed to the ulnar edge of the palmar surface of the second finger and the palmar surfaces of the adjacent edges of the third through fifth fingers. The left superficial palmar arch had an atypical structure located under the palmar aponeurosis at the level of the middle of the metacarpals and formed by the terminal parts of the ulnar and anterior interosseous arteries. Because the radial artery in this fetus was traced to the distal part of the forearm (to the scaphoid bone), we did not find branches of this artery in the palm area, especially the superficial palmar branch of the radial artery. The ulnar artery was directed caudally to the palmar region, curving slightly in an arc to the radial side of the hand. From the terminal portion of the ulnar artery, three common palmar finger arteries bifurcated, which in turn bifurcated into five palmar finger arteries of their own. The latter supplied the ulnar edge of the third finger and the palmar areas of the fourth and fifth fingers. The radial edge of the third finger and the palmar areas of the II-I fingers were supplied by five separate palmar arteries originating from the terminal portion of the anterior interosseous artery. Anastomoses were found between the palmar arteries, mainly in the middle and terminal phalanges. In the area of the palm, numerous muscular branches bifurcated from the anterior interosseous and ulnar arteries, providing blood supply to the palm muscles. Conclusions. In the majority of the studied fetuses (82.61 %) the superficial palmar arch was closed, in 17.39 % of the observations it was not closed. In 10.5 % of cases, the superficial palmar arch was formed by the trunk of the ulnar artery and the median forearm artery, and in 5.2 % - with the participation of the ulnar and anterior interosseous arteries. The ulnar artery is predominantly involved in the formation of the superficial palmar arch. In a fetus with a PCL of 210.0 mm, the right brachiocephalic artery was found, as well as a high origin of the right ulnar artery from it and an atypical branching of other branches. In particular, the superficial palmar arch was formed by the superficial palmar branch of the brachial radial artery, the terminal ulnar artery, and the anterior interosseous artery, while the left superficial palmar arch was formed by the terminal ulnar and anterior interosseous arteries. [ABSTRACT FROM AUTHOR]

An 83‐year‐old Chinese man presented with a huge left chest wall hematoma and hemorrhagic shock 4 months after permanent pacemaker implantation. Computed Tomography of Angiogram of the left subclavian artery revealed a pseudoaneurysm. He underwent radiologically guided stenting followed by hematoma clearance. It is rare to have delayed formation of pseudoaneurysm at 4 months post pacemaker implantation. Radiologically guided stenting is the preferred treatment, followed by hematoma clearance. It is strongly advised against blind surgery for wound debridement or bleeding detection. Familiarizing with axillary vein anatomy, improving axillary vein cannulation skills, and detecting early complications of artery injury are key strategies in preventing pseudoaneurysm formation post pacemaker implantation. [ABSTRACT FROM AUTHOR]

Background: Stent-graft placement is generally used to treat pseudoaneurysm (PSA) of the axillary artery (AA) trunk to maintain the patency of peripheral vessels. Coil embolization of a PSA associated with a disrupted AA trunk has rarely been reported. Case presentation: A 54-year-old woman presented with swelling of her right shoulder. She had had a right proximal humeral fracture 12 years earlier. Contrast-enhanced computed tomography (CECT) and subsequent angiograms revealed a giant PSA at the disrupted, distal right AA. There were collateral flows to the brachial artery from the proximal to the right AA. To preserve collateral flows to the brachial artery, selective embolization of the inflow artery that derived from the distal AA was performed with hydrogel-coated coils. The post-embolization arteriogram showed no flow into the PSA, but collateral flows to the brachial artery we preserved. The post-embolization course was uneventful. The patient regained warmth in her right arm and hand on post-embolization day 4. Repeat CECT on post-embolization day 9 confirmed blood-flow to her right radial artery. Conclusions: While a stent-graft should be used if the AA trunk can be preserved, coil embolization should be considered for PSA if the AA trunk is disrupted but collaterals are preserved. [ABSTRACT FROM AUTHOR]

Costoclavicular block has garnered the attention of regional anesthesia enthusiasts because the cords are snuggly packed and consistently arranged in a particular pattern around the first part of the axillary artery. The single injection technique has been widely used conventionally, but the effect is unpredictable. The effect is unpredictable because of the septum that compartmentalizes cords in upper and lower compartments. We propose a triple injection technique targeting the individual cords separately. Onset time of sensory block from 16 min to 7 min. The average time for a complete motor block was 9.6 min. The chances of the median nerve sparing, as has been reported in some cases in previous studies, are almost nil by this technique–the corner pocket injection that involves the medial root of the median nerve and the lateral cord that is specifically blocked separately, covering the lateral root of the median nerve. The costoclavicular block has already carved a niche as an excellent choice for surgeries of the upper limb involving the elbow or below the elbow. The use of the triple injection technique makes the block effect more predictable and reliable. [ABSTRACT FROM AUTHOR]

Percutaneous axillary artery access is increasingly used for large-bore access during interventional vascular and cardiac procedures. The aim of this study was to evaluate the safety and learning curve of percutaneous axillary artery access in patients undergoing complex endovascular aortic repair (fenestrated and branched endovascular aneurysm repair [FBEVAR]) requiring large-bore upper extremity access and to discuss best practices for technique and complication management. One-hundred forty-six patients undergoing large-bore percutaneous axillary artery access during FBEVAR in a prospective, nonrandomized, Investigational Device Exemption study between September 2017 and January 2023 were analyzed. Ultrasound guidance and micropuncture were used to access the second portion of the axillary artery and 2 Perclose Proglide or Prostyle devices (Abbott Vascular) were predeployed before the insertion of the large-bore sheath. Completion angiography was performed in all patients to verify hemostatic closure. Axillary artery patency was also assessed on follow-up computed tomography angiography. Patient-related, procedural, and postoperative variables were collected and analyzed. One-hundred forty-five patients underwent successful percutaneous axillary artery access; 1 patient failed axillary access and alternative access was established. The left axillary artery was accessed in 115 patients (79%), and the right axillary artery was accessed in 30 patients (21%). The largest profile sheath was 14 F in 4 patients (2.8%), 12F in 133 patients (91.7%), and 8F in 8 patients (5.5%). Ten patients (6.9%) required covered stent placement (Viabahn, W. L. Gore & Associates) for failure to achieve hemostasis; there were no conversions to open surgical repair. Additional adverse events included transient upper extremity weakness in two patients (1.3%) and transient upper extremity paresthesias in two patients (1.3%). Three patients (2%) suffered postoperative strokes, including one unrelated hemorrhagic stroke and two possibly access-related embolic strokes. On follow-up, axillary artery patency was 100%. There was a trend toward decreased closure failure over time, with seven patients (10%) in the early cohort and three (4%) in the late cohort. There was a significant negative correlation between the cumulative complication rate and the cumulative experience. Large-bore percutaneous axillary artery access provides safe upper extremity large-bore access during FBEVAR, achieving successful closure in >90% of patients with a low incidence of access-related complications. There was a trend toward better closure rates with increasing experience, suggesting a learning curve effect. Application of best practices including ultrasound guidance and angiography may ensure safe application of the technique of percutaneous large-bore axillary artery access. [ABSTRACT FROM AUTHOR]

Upper extremity true arterial aneurysms are rare and often present as a pulsatile mass with associated pain and paresthesia from peripheral nerve compression, and can lead to acute limb ischemia from thromboembolic sequela. History of arteriovenous dialysis access and immunosuppression after renal transplantation may contribute to the development of true aneurysms.This report describes the management of a patient with end-stage renal disease (ESRD) with multiple left upper extremity dialysis access who presented with an axillary and brachial artery aneurysm.

Temporary mechanical circulatory support is a treatment of choice for patients in severe cardiogenic shock. Combining veno-arterial extracorporeal life support (ECLS) with devices that enable left ventricular unloading emerges as a promising strategy to diminish detrimental effect of elevated left ventricular afterload and to improve survival. However, the need to establish multiple arterial access sites remains a major drawback of this approach due to a significant rate of vascular complications. We describe herein a case of a single arterial access for ECLS and intra-aortic balloon pump using axillary artery that may provide a simple, modular and flexible approach for escalation or de-escalation of mechanical circulatory support. [ABSTRACT FROM AUTHOR]

Minipigs are used as in vivo endovascular models, particularly in stroke and aneurysm research. However, detailed knowledge of the diameters of forelimb arteries that are commonly used as surrogates for human brain–supplying arteries are lacking. This study aimed to determine the diameters of forelimb and neck arteries in Aachen minipigs and to compare those to the diameters of human cerebral brain–supplying arteries in order to assess the validity of the Aachen minipig as a human intracranial in vivo model. We measured the diameters in the external carotid artery and eight different branches of the subclavian artery in 12 Aachen minipigs using angiographic imaging. Analysed arteries comprised the external carotid artery, axillary artery, brachial artery, subscapular artery first segment, subscapular artery second segment, external thoracic artery, caudal circumflex humeral artery, suprascapular artery and thoracodorsal artery. We compared these diameters to diameters of the following human brain–supplying arteries: terminal internal carotid artery (carotid-T and petrous segment), M1 segment of the middle cerebral artery, M2 segments of the middle cerebral artery, anterior cerebral artery, vertebral artery and basilar artery. Median diameters of porcine forelimb arteries ranged from 1.8 to 4.9 mm, and human brain supplying arteries ranged in diameter from 1.4 to 4.3 mm. Depending on the intended use, this allows porcine forelimb arteries to be selected which are statistically comparable to human brain–supplying vessels. In conclusion, we identified several equivalent arteries of the porcine subclavian branches that are comparable to human brain–supplying arteries. This may help to validate the minipig as a suitable in vivo model for neurovascular experiments. [ABSTRACT FROM AUTHOR]

Background Thoracic endovascular aortic repair (TEVAR) has been widely introduced. However, unestablished transfemoral approach due to true lumen obliteration disables endovascular option. Case summary A 74-year-old male with a history of 15-year-ago type B aortic dissection presented with chronic bilateral lower extremity claudication. CT angiography revealed that a large entry tear was located at distal to the left subclavian artery. The thoracic aneurysmal degeneration progressed and eventually required repair. True lumen of infrarenal aorta to bilateral common iliac arteries was totally collapsed by false lumen, and the re-entry tear was open at external iliac artery. Initially, we performed recanalization to the collapsed true lumen. Bidirectional approach was taken from right brachial and bifemoral arteries. The covered endovascular reconstruction of aortic bifurcation (CERAB) technique and double D-shape moulding technique (DDMT) was performed to create covered stent configuration. As secondary treatment, 1-debranching TEVAR with axillary artery bypass was successfully performed by utilizing femoral approach. Discussion This case demonstrated feasibility of two-stage endovascular therapy for thoracic aneurysmal degeneration concomitant with true lumen obliteration. This combined technique of CERAB and DDMT was absolutely effective to minimize type Ⅲ endoleak in infrarenal segment. Hybrid endovascular treatment offered minimally invasive therapy to the patient. [ABSTRACT FROM AUTHOR]

Background: TAVI indications expand not only to low-risk patients but also to patients with a more complex anatomy and comorbidities. Transfemoral retrograde access is recognized as the first preferred approach according to the current guidelines. However, this approach is not suitable in up to 10–15% of patients, for whom an alternative non-femoral access route is required. Case Presentation: An 83-year-old male patient with known aortic isthmus stenosis presented with severe symptomatic aortic stenosis. Computed tomography revealed a subtotal isthmus stenosis, directly after left subclavian artery origin, with many collaterals extending toward the axillary and subclavian arteries. Duplex ultrasound verified the proximal diameter of the left brachial artery to be 5.5 mm. A successful surgical cutdown trans-brachial TAVI with an Evolut prosthetic valve with a size of 29 mm was performed. On the fourth postoperative day, the patient was discharged, and the three-month follow-up was uneventful. Conclusion: In patients with aortic isthmus stenosis, the brachial artery could be a feasible alternative, as a less invasive access site, which can be determined after careful assessment of the vessel diameter. More data are required to evaluate the safety and efficacy of this access route and to achieve more technical improvements to increase operator familiarity with it. [ABSTRACT FROM AUTHOR]

Percutaneous transaxillary approach (PTAX) through the first segment of the axillary artery is not widely recognized as a safe method. Furthermore, PTAX has never been directly compared between Impella-supported percutaneous coronary interventions (Impella-PCI) and transcatheter aortic valve replacement (TAVR). This study evaluated the feasibility and safety of PTAX through the first axillary segment in Impella-PCI versus TAVR. In cases where standard imaging guidance was insufficient, a technique involving puncturing the axillary artery "on-the-balloon" was employed. The endpoints were bleeding and vascular complications, as defined by BARC and VARC-3 criteria. PTAX was successfully performed in all 46 attempted cases: 23 for Impella-PCI and 23 for TAVR. Strict adherence to BARC and VARC-3 criteria led to the frequent identification of major bleeding (57%) and a moderately frequent diagnosis of vascular complications (17%). These incidences were primarily based on post-procedural hemoglobin reduction (> 3 g/dl) but not overt bleeding. The Impella group exhibited a higher rate of BARC 3b bleeding due to a greater hemoglobin decline resulting from the prolonged implant duration and PCI itself. Left axillary access was linked to smaller blood loss. Bleeding and vascular complications, as per BARC and VARC-3 definitions, did not affect short-term prognosis, with only 3 Impella patients succumbing to heart failure unrelated to the procedures during one-month follow-up period. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic vascular injury is a significant cause of morbidity and sometimes mortality, depending on the associated mode and level of injury; hence should be dealt with on an emergency basis considering hemodynamic status of the patient and the level of expertise available at the center. Most common forms of vascular injury include penetrating trauma and blunt trauma. Nowadays iatrogenic arterial injury is another emerging cause of vascular trauma. Vascular injuries, such as vasospasm, contusion, intimal flaps, intimal disruption or hematoma, external compression, laceration, transection and focal wall defects with pseudoaneurysm etc are different types of vascular injuries. Case report: A 23 year old male was referred to EMD 8 hours after a motorcycle collision. On arrival, the patient's vitals were stable, and he complained of right shoulder pain and an absence of motor and sensory functions below the right shoulder. On examination, his right upper limb was cold, pale, pulseless with saturation < 80% and no withdrawal reflex upon painful stimulation. The injury was associated with swelling, tenderness, crepitus, abnormal mobility and deformity in the right mid arm with a subcutaneous hematoma of 10x4cm in the same region. Conclusion: For selective cases in emergency conditions, especially where ischemic time is already prolonged, in a case of subclavian artery trauma or occlusion, carotid to axillary/brachial bypass is less time-consuming and less risky by avoiding time and efforts necessary for exposure of the proximal part of the subclavian artery, which is required for subclavian to brachial artery anastomosis. Hence in this case jump graft is a comparatively preferred choice than interposition graft for earliest reperfusion of the limb. [ABSTRACT FROM AUTHOR]

Objective The main objective of this study was to analyse the prevalence and characteristics of subclinical GCA in patients with PMR. Methods This was a cross-sectional multicentre international study of consecutive patients with newly diagnosed PMR without symptoms or signs suggestive of GCA. All patients underwent US of the temporal superficial, common carotid, subclavian and axillary arteries. Patients with halo signs in at least one examined artery were considered to have subclinical GCA. The clinical, demographic and laboratory characteristics of the PMR group without subclinical vasculitis were compared with subclinical GCA, and the pattern of vessel involvement was compared with that of a classical single-centre GCA cohort. Results We included 346 PMR patients, 267 (77.2%) without subclinical GCA and 79 (22.8%) with subclinical GCA. The PMR patients with subclinical GCA were significantly older, had a longer duration of morning stiffness and more frequently reported hip pain than PMR without subclinical GCA. PMR with subclinical GCA showed a predominant extracranial large vessel pattern of vasculitic involvement compared with classical GCA, where the cranial phenotype predominated. The patients with PMR in the classical GCA group showed a pattern of vessel involvement similar to classical GCA without PMR but different from PMR with subclinical involvement. Conclusion More than a fifth of the pure PMR patients had US findings consistent with subclinical GCA. This specific subset of patients showed a predilection for extracranial artery involvement. The optimal screening strategy to assess the presence of vasculitis in PMR remains to be determined. [ABSTRACT FROM AUTHOR]

Background: Brachial artery (BA) is the main arterial supply to upper limb, it's a direct continuation of axillary artery at the lower border of teres major and gives of profunda brachii which is the largest branch, superior ulnar collateral artery, inferior ulnar collateral artery, nutrient artery and muscular branches. BA presents with a lot of anatomical variants as reported by several authors though there is paucity of data on this variant anatomy among black African population. The current study evaluated variation in origin and course of brachial artery among black African population. Methodology: This descriptive cross-sectional study was carried out in three universities, in western Kenya due to their well-established functional Human Anatomy laboratory used by medical students. The study involved 77 cadavers (n=154 upper limbs) of 39 males and 38 females obtained through stratified sampling technique. Data collected was collated in excel sheet and analyzed using statistical package of social sciences (SPSS) version 26.0. Descriptive statistics was used to assess frequency distribution of variant origin while Chi square was used to determine difference in proportion of normal origin and cumulative variation of BA regards with to laterality of the upper limb. Brachium region was exposed to access the brachial artery where origin and its course was assessed. Results: Out of 154 upper limbs examined 3.8% had variation in origin of brachial artery, 2.6% showed superficial origin and superficial course of brachial artery terminating into its terminal branches. However, this variation was not statistically significant. Conclusion: There were variations in origin of brachial artery among black African population, these variations were more on the right upper limb than the left upper limb, though not statistically significant but clinically significant, hence health care professionals, anatomists and medical students should be made aware of such variants when performing invasive procedures to avoid complications, misdiagnosis and any medical errors that might occur as a result of such variants. Understanding existence of such variants leads to good patient care and outcome after surgical and radiological procedures thus reducing misdiagnosis and mismanagement of patients. [ABSTRACT FROM AUTHOR]

A technique called arch-clamping was used at our institute to ensure perfusion of the lower body and brain during total arch replacement with frozen elephant trunk (TAR and FET). The aortic arch clamp is inserted between the left common carotid artery and the left subclavian artery after inserting the stented elephant trunk into the true lumen of the descending aorta during the procedure, and then clamps the aorta and graft together as the distal anastomotic edge of the aorta. After the arch clamp was in place, lower body perfusion was resumed through the femoral artery was resumed and time to circulatory arrest was reduced to approximately 4 min. Cardiopulmonary bypass (CPB) flow was gradually restored to full rate. Thereafter, the left carotid artery anastomosis was completed and rewarming began. Finally, during the rewarming period, other branches of the aortic arch and ascending aorta were reconstructed. In this paper, we describe the perfusion management strategy, discuss intraoperative monitoring parameters, and examine the feasibility of the technique from a perfusion perspective. [ABSTRACT FROM AUTHOR]

Background: Acute upper‑limb ischemia (AULI) is not always as limb‑threatening as those in the leg, so thrombo‑embolectomy is not always as necessary for limb salvage. Objective: To evaluate “the outcomes of limb and life at the end of one month, in patients with AULI” and to analyze the following factors: presentation from the time of the acute event, evaluation of limb at the time of presentation regarding its viability, and compare the outcomes in early presentation vs late presentation. Methodology: This was a retrospective study; hence, clinical profiles of all patients during the past seven years were reviewed for those presenting with AULI. Data on anticoagulation were collected, imaging and operative procedures were extracted. All statistical analyses were performed using SPSS 11.0 for Windows. Results: In our study, 25 (42.4%) patients were included due to native arterial thrombosis, 11 (18.6%) due to embolic disease, and the same percentage due to exposure to a high‑altitude area (HAA) (more than 9000 feet). 4 (6.8%) patients had thoracic outlet syndrome and cervical rib, and 5 (8.5%) had hypercoagulable disorder. Our study population was younger with a mean of 44.9 years with an SD of 13, and the majority were male (5 out of 59 were female). 16 were active smokers, and 2 were former smokers. The left upper limb incidence was 59% (n = 35), and the right upper limb was 41% (n = 24). In our study, the most common site was the brachial artery 53% (26 out of 49) and axillary artery 35% (17 out of 49) when iatrogenic, traumatic, and thoracic outlet syndromes are excluded. Out of the 59 patients, 39 patients had undergone color Doppler flow imaging of the affected limb and 30 patients had undergone CT angiography of the arch and the limb. Two patients presented with gangrene to the forearm, and 12 patients underwent Colour doppler flow imaging (CDFI) before they presented to our center. In our study, 37% of the patients presented within 48 hours of the onset of symptoms, out of which above‑elbow amputation was done in only 1 patient, that is, 4.5%, and 24% of the patients presented within an 8–14‑day period, among which one patient (11%) had undergone above‑elbow amputation and 22% of the patients presented after 14 days, in which there were 2 above‑elbow‑amputation patients (15%) with a statistically non‑significant P value of 0.5. A total of 45 patients were managed with anticoagulation. A detailed discussion on the treatment outcome of each case has been presented in the article. Conclusion: CT angiography, when available, is a well‑accepted first‑line investigation for AULI. When we compare AULI with lower‑limb ischemia, collateral circulation conservative management is also an option, provided that it is not associated with tissue loss. AULI like lower‑limb ischemia has better limb salvage when diagnosed and intervened early. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine whether an ultrasound-guided infraclavicular cannulation of the axillary artery is noninferior to an ultrasound-guided cannulation of the common femoral artery for arterial catheter placement in critically ill patients. DESIGN: Prospective, investigator-initiated, noninferiority randomized controlled trial. SETTING: University-affiliated ICU in Poland. PATIENTS: Mechanically ventilated patients with indications for arterial catheter placement. INTERVENTIONS: Patients were randomly assigned into two groups. In the axillary group (A group), an ultrasound-guided infraclavicular, in-plane cannulation of the axillary artery was performed. In the femoral group (F group), an ultrasound-guided, out-of-plane cannulation of the common femoral artery was performed. MEASUREMENTS AND MAIN RESULTS: A total of 1,079 mechanically ventilated patients were screened, of whom 110 were randomized. The main outcome was the cannulation success rate. The secondary outcomes included the artery puncture success rate, the first-pass success rate, number of attempts required to puncture, and the rate of early mechanical complications. The cannulation success rate in the A group and F group was 96.4% and 96.3%, respectively. The lower limit of 95% CI for the difference in cannulation success rate was above the prespecified noninferiority margin of—7% demonstrating noninferiority of infraclavicular approach. No significant differences were found between the groups in terms of puncture success rate and the rate of early mechanical complications. CONCLUSIONS: An ultrasound-guided infraclavicular cannulation of the axillary artery is noninferior to the cannulation of the common femoral artery in terms of procedure success rate. We found no significant differences in early mechanical complications between the groups. [ABSTRACT FROM AUTHOR]

Background: The brachial artery is the extension of the axillary artery starting at the lower margin of the teres major muscle and is the major artery of the upper extremity. The brachial artery reaches the cubital fossa and bifurcates into the radial and ulnar artery. Aim: To study the variations in brachial artery in cadavers. Material and Methods: Dissection of the upper limb in dissection hall of anatomy department. Result: Among the 30 cadavers, variations were found in 5 cadavers which includes 4 males and 1female cadaver of age 56 years Male, and 61 years Female, 68 years Male, 64 years Male and 51 years Male. It is noted that Accessory brachial artery was arising from the axillary artery at the lower border of teres major along with main brachial artery in these 5 cadavers accounting for 16.66% variation. Accessory brachial artery was placed superficially and medially, compared to main brachial artery, which was placed deeply and laterally. Conclusion: When undergoing vascular and reconstructive procedures on the arms and forearms, precise understanding of the anatomical variations of the brachial artery's course, branching, bifurcation/termination, the path of its terminal branches, and connection with the surrounding structures is crucial. The brachial artery anatomical changes found in this study are uncommon and have significant clinical implications. The superficial auxiliary ulnar arteries and accessory brachial arteries identified in this study could be misdiagnosed as veins, which could make intravenous medication delivery, venipuncture procedures more difficult, and percutaneous brachial catheterization more difficult. Anatomists, radiologists, orthopaedist vascular surgeons, and plastic surgeons all need to have a thorough understanding of these vascular variances. [ABSTRACT FROM AUTHOR]

Background and Objectives: Postoperative neurological complications (NCs) are an important cause of mortality in patients with acute type A aortic dissection (ATAAD). The aim of the study was to determine the association between intraoperative risk factors and newly developed postoperative NCs in patients after emergency surgery for ATAAD. Materials and Methods: A total of 203 patients requiring emergency surgery were included in the study. Patients with preoperative neurological dysfunction, deceased on the operating table or within the first 48 h after intensive care admission, with uncertain postoperative neurologic status or with incomplete records were excluded. Results: Mean age was 57.61 ± 12.27 years. Hyperlipidemia was the most frequent comorbidity (69%). A bicuspid aortic valve was present in 12.8% of cases, severe acute aortic regurgitation was present in 29.1% of patients, and cardiac tamponade was present in 27.1% of cases. The innominate artery was the most frequently dissected supra-aortic artery in 27.1% of cases. In 65% of cases, the primary entry tear was at the level of the ascending aorta. The incidence of newly developed postoperative NCs was 39.4%. The most common surgical technique performed was supra-coronary ascending aorta and hemiarch replacement, in 53.2% of patients. Using logistic regression, cardiopulmonary bypass time (OR = 1.01; 95% CI = 1.01–1.02; p < 0.001), aortic cross-clamp time over 3 h (OR = 2.71, 95% CI = 1.43–5.14, p = 0.002) and cerebral perfusion time (OR = 1.02; 95% CI = 1.002–1.03; p = 0.027) were independently associated with newly developed postoperative NCs. Conclusions: Based on the results of the study, all efforts should be made to reduce operative times. Using a simple surgical technique, like the supra-coronary ascending aorta and hemiarch technique, whenever possible, and using a simpler technique for cerebral perfusion like unilateral cerebral perfusion via the right axillary artery, could reduce operating times. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Inferior shoulder dislocation is a rare type of glenohumeral joint dislocation. A serious complication to shoulder dislocation is axillary artery injury, which should be taken into consideration early to avoid potentially permanent damage. Literature on artery injury following inferior shoulder dislocation is sparse. Case Report: We report the case of a 71-year-old man with a traumatic inferior shoulder dislocation due to a fall. The patient had a medical history of stroke, and thus had a daily intake of 10 mg Warfarin. Previously, he had reported 2 anterior shoulder dislocations. The shoulder reduction was conducted under general anaesthesia after reduction with intravenous morphine sedation. Six hours after reduction, the patient showed signs of hemodynamic instability and a CT scan with contrast showed a suspected axillary artery rupture with a large hematoma in the right axilla. The artery rupture was confirmed with an arteriogram. The patient was successfully treated with an endovascular stent. After 3 months, the patient had normal neurovascular status in the right upper extremity and was continuing rehabilitation of the shoulder. Conclusions: This case emphasizes the importance of proper recognition and awareness of artery injury after inferior shoulder dislocation. The symptoms of artery rupture after inferior shoulder dislocation can be immediate or have a late onset. The diagnostic modalities of CT scan with contrast or arteriogram should be performed with a low threshold of suspicion after reduction. With symptoms such as enlarging hematoma in the axilla, diminished radial and ulnar pulse, sudden pain from the axilla, or signs of hemodynamic instability after reduction, diagnostic modalities should be considered. [ABSTRACT FROM AUTHOR]

The intercostobrachial nerve (ICBN) originates from the second intercostal nerve's lateral cutaneous branch, while the median nerve (MN) typically arises from the brachial plexus's lateral and medial roots. The medial cutaneous nerve of the arm, a branch of the medial cord of the brachial plexus, often connects with the ICBN. Variations were observed during the dissection of a 50-year-old male cadaver, including MN having two lateral roots (LR), LR1 and LR2, joining at different levels. Three ICBNs innervated the arm in this case, with the absence of the medial cutaneous nerve of the arm compensated by branches from the medial cutaneous nerve of the forearm. Understanding these anatomical variations is crucial for surgical procedures like brachioplasty, breast augmentation, axillary lymph node dissection, and orthopedic surgery. Surgeons and medical professionals must be aware of these variations to enhance preoperative planning, minimize complications, and improve patient outcomes in these procedures. [ABSTRACT FROM AUTHOR]

Objectives To determine whether the halo count (HC) on temporal and axillary artery US (TAUS) predicts time to relapse in giant cell arteritis (GCA). Methods We conducted a single-centre retrospective study of GCA patients. HC, the number of vessels with non-compressible halo on the TAUS at diagnosis, was determined by retrospective review of the US report and images. Relapse was defined as increase in GCA disease activity requiring treatment escalation. Cox proportional hazard regression was used to identify predictors of time to relapse. Results A total of 72 patients with confirmed GCA were followed up for a median of 20.9 months. Thirty-seven of 72 (51.4%) relapsed during follow-up, at a median prednisolone dose of 9 mg (range 0–40 mg). Large-vessel (axillary artery) involvement did not predict relapse. On univariable analysis, a higher HC was associated with shorter time to relapse (per-halo hazard ratio 1.15, 95% CI 1.02, 1.30; P  = 0.028). However, statistical significance was lost when the 10 GCA patients with an HC of zero were excluded from analysis. Conclusion In this real-world setting, relapse occurred at a wide range of glucocorticoid doses and was not predicted by axillary artery involvement. GCA patients with a higher HC at diagnosis were significantly more likely to relapse, but significance was lost on excluding those with HC of zero. HC is feasible in routine care and may be worth incorporating into future prognostic scores. Further research is required to determine whether confirmed GCA patients with negative TAUS represent a qualitatively different subphenotype within the GCA disease spectrum. [ABSTRACT FROM AUTHOR]