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Mariano E Menendez - One of the best experts on this subject based on the ideXlab platform.
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Axillary Artery injury associated with proximal humerus fracture a report of 6 cases
The archives of bone and joint surgery, 2017Co-Authors: Rinne M Peters, Mariano E Menendez, Jos J Mellema, David Ring, Malcolm R SmithAbstract:Â Proximal humerus fractures are common, but associated injury of the Axillary Artery is uncommon. The majority of published blunt traumatic Axillary Artery injuries are associated with anterior glenohumeral dislocation; a few are associated with isolated proximal humerus fractures or fracture-dislocation. Experience within our institution demonstrates that Axillary Artery injury is often unrecognized on initial presentation owing to palpable peripheral pulses and the absence of ischemia and places the hand at risk of necrosis and amputation if there is prolonged ischemia and the forearm at risk of compartment syndrome after revascularization. Accurate physical examination in combination with a low threshold for Doppler examination or angiography can establish the diagnosis of Axillary Artery injury. We present 6 cases of Axillary Artery injury associated with proximal humerus fractures in order to highlight the potential for this vascular injury in the setting of a proximal humerus fracture.
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proximal humerus fracture with injury to the Axillary Artery a population based study
Injury-international Journal of The Care of The Injured, 2015Co-Authors: Mariano E Menendez, David Ring, Marilyn HengAbstract:Abstract Background The available evidence regarding Axillary Artery injury as a result of proximal humerus fracture consists of individual case reports or small series. This study used nationally representative data to determine the prevalence and predictors of Axillary Artery injury secondary to proximal humerus fracture, and to characterise its influence on inpatient mortality, length of stay, cost and discharge disposition. Methods An estimated 388,676 inpatients with a proximal humerus fracture were identified in the Nationwide Inpatient Sample between 2002 and 2011, 331 with concomitant Axillary Artery injury (8.5 per 10,000). Multivariable regression modelling was used to identify independent predictors of Axillary Artery injury and to assess its relationship with inpatient outcomes. Results Factors associated with Axillary Artery injury were male sex (odds ratio (OR): 1.6, 95% confidence interval (CI): 1.2–2.0), atherosclerosis (OR: 3.7, 95% CI: 2.5–5.4), open fracture (OR: 2.9, 95% CI: 1.9–4.5) and the presence of concomitant injuries, including brachial plexus injury (OR: 109, 95% CI: 79–151), shoulder dislocation (OR: 3.4, 95% CI: 2.0–5.8), scapula fracture (OR: 3.4, 95% CI: 2.1–5.4) and rib fracture (OR: 2.5, 95% CI: 1.6–4.0). Axillary Artery injury was associated with increased length of stay, costs and mortality, but it did not affect discharge disposition. Conclusion Our study provides important baseline information regarding the epidemiology of Axillary Artery injury secondary to proximal humerus fracture. Prompt identification of at-risk patients upon admission might lead to improved diagnosis and management of this vascular injury. Level of Evidence Prognostic level II.
Marilyn Heng - One of the best experts on this subject based on the ideXlab platform.
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proximal humerus fracture with injury to the Axillary Artery a population based study
Injury-international Journal of The Care of The Injured, 2015Co-Authors: Mariano E Menendez, David Ring, Marilyn HengAbstract:Abstract Background The available evidence regarding Axillary Artery injury as a result of proximal humerus fracture consists of individual case reports or small series. This study used nationally representative data to determine the prevalence and predictors of Axillary Artery injury secondary to proximal humerus fracture, and to characterise its influence on inpatient mortality, length of stay, cost and discharge disposition. Methods An estimated 388,676 inpatients with a proximal humerus fracture were identified in the Nationwide Inpatient Sample between 2002 and 2011, 331 with concomitant Axillary Artery injury (8.5 per 10,000). Multivariable regression modelling was used to identify independent predictors of Axillary Artery injury and to assess its relationship with inpatient outcomes. Results Factors associated with Axillary Artery injury were male sex (odds ratio (OR): 1.6, 95% confidence interval (CI): 1.2–2.0), atherosclerosis (OR: 3.7, 95% CI: 2.5–5.4), open fracture (OR: 2.9, 95% CI: 1.9–4.5) and the presence of concomitant injuries, including brachial plexus injury (OR: 109, 95% CI: 79–151), shoulder dislocation (OR: 3.4, 95% CI: 2.0–5.8), scapula fracture (OR: 3.4, 95% CI: 2.1–5.4) and rib fracture (OR: 2.5, 95% CI: 1.6–4.0). Axillary Artery injury was associated with increased length of stay, costs and mortality, but it did not affect discharge disposition. Conclusion Our study provides important baseline information regarding the epidemiology of Axillary Artery injury secondary to proximal humerus fracture. Prompt identification of at-risk patients upon admission might lead to improved diagnosis and management of this vascular injury. Level of Evidence Prognostic level II.
David Ring - One of the best experts on this subject based on the ideXlab platform.
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Axillary Artery injury associated with proximal humerus fracture a report of 6 cases
The archives of bone and joint surgery, 2017Co-Authors: Rinne M Peters, Mariano E Menendez, Jos J Mellema, David Ring, Malcolm R SmithAbstract:Â Proximal humerus fractures are common, but associated injury of the Axillary Artery is uncommon. The majority of published blunt traumatic Axillary Artery injuries are associated with anterior glenohumeral dislocation; a few are associated with isolated proximal humerus fractures or fracture-dislocation. Experience within our institution demonstrates that Axillary Artery injury is often unrecognized on initial presentation owing to palpable peripheral pulses and the absence of ischemia and places the hand at risk of necrosis and amputation if there is prolonged ischemia and the forearm at risk of compartment syndrome after revascularization. Accurate physical examination in combination with a low threshold for Doppler examination or angiography can establish the diagnosis of Axillary Artery injury. We present 6 cases of Axillary Artery injury associated with proximal humerus fractures in order to highlight the potential for this vascular injury in the setting of a proximal humerus fracture.
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proximal humerus fracture with injury to the Axillary Artery a population based study
Injury-international Journal of The Care of The Injured, 2015Co-Authors: Mariano E Menendez, David Ring, Marilyn HengAbstract:Abstract Background The available evidence regarding Axillary Artery injury as a result of proximal humerus fracture consists of individual case reports or small series. This study used nationally representative data to determine the prevalence and predictors of Axillary Artery injury secondary to proximal humerus fracture, and to characterise its influence on inpatient mortality, length of stay, cost and discharge disposition. Methods An estimated 388,676 inpatients with a proximal humerus fracture were identified in the Nationwide Inpatient Sample between 2002 and 2011, 331 with concomitant Axillary Artery injury (8.5 per 10,000). Multivariable regression modelling was used to identify independent predictors of Axillary Artery injury and to assess its relationship with inpatient outcomes. Results Factors associated with Axillary Artery injury were male sex (odds ratio (OR): 1.6, 95% confidence interval (CI): 1.2–2.0), atherosclerosis (OR: 3.7, 95% CI: 2.5–5.4), open fracture (OR: 2.9, 95% CI: 1.9–4.5) and the presence of concomitant injuries, including brachial plexus injury (OR: 109, 95% CI: 79–151), shoulder dislocation (OR: 3.4, 95% CI: 2.0–5.8), scapula fracture (OR: 3.4, 95% CI: 2.1–5.4) and rib fracture (OR: 2.5, 95% CI: 1.6–4.0). Axillary Artery injury was associated with increased length of stay, costs and mortality, but it did not affect discharge disposition. Conclusion Our study provides important baseline information regarding the epidemiology of Axillary Artery injury secondary to proximal humerus fracture. Prompt identification of at-risk patients upon admission might lead to improved diagnosis and management of this vascular injury. Level of Evidence Prognostic level II.
Clement R Darling - One of the best experts on this subject based on the ideXlab platform.
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percutaneous Axillary Artery access for endovascular interventions
Journal of Vascular Surgery, 2018Co-Authors: Emily Harris, Courtney J Warner, Jeffrey Hnath, Yaron Sternbach, Clement R DarlingAbstract:Abstract Background As endovascular therapy becomes increasingly complex, adjunct techniques such as upper extremity arterial access facilitate visceral branch interventions. The purpose of this study was to assess the viability of Axillary Artery percutaneous access in endovascular repair. Methods Records of all patients undergoing Axillary Artery percutaneous access as part of an endovascular intervention from December 2015 to December 2016 were examined. Demographics of the patients (age, sex, medical comorbidities, smoking status, and anticoagulation) were documented. Each case was examined for technical success and perioperative complications, including hematoma, brachial plexus injury, and return to the operating room. Early functional outcomes were assessed using clinic follow-up documentation. Results During the study interval, 25 Axillary Artery punctures in a total of 19 patients were performed for endovascular intervention. The mean age was 72 years; most patients were male (68%), and the cohort had a typical vascular comorbidity profile (hypertension in 84%, hyperlipidemia in 90%, diabetes in 21%, coronary Artery disease in 58%, and chronic obstructive pulmonary disease in 47%; 90% were active or former smokers). Axillary access was obtained as part of complex endovascular aneurysm repair in 13 patients, mesenteric vessel intervention in 3 patients, and iliac intervention in 3 patients. Sheath size was most frequently 6F (6 punctures) or 7F (15 punctures). Closure devices included Perclose (Abbott Vascular, Santa Clara, Calif) in 36% and Angio-Seal (Terumo Interventional Systems, Somerset, NJ) in 64%. There were two perioperative deaths and one instance of return to the operating room for hematoma. There was no perioperative stroke, Axillary occlusion, or severe brachial plexus injury. One patient had transient ipsilateral postoperative thumb numbness, and one patient had residual bleeding after closure requiring manual pressure. Conclusions Percutaneous Axillary Artery access is a viable strategy to facilitate complex endovascular interventions. This technique avoids the need for brachial or Axillary Artery exposure and allows larger sheath sizes because of the caliber of the Axillary Artery. There were no major neurologic or ischemic complications. This technique is a relatively safe and practical alternative to approaches involving exclusively femoral and brachial access.
Ramazan Kutlu - One of the best experts on this subject based on the ideXlab platform.
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aberrant right subclavian Artery and Axillary Artery cannulation in type a aortic dissection repair
The Annals of Thoracic Surgery, 2013Co-Authors: Bektas Battaloglu, Nevzat Erdil, Serkan Secici, Cengiz Colak, Olcay Murat Disli, Ramazan KutluAbstract:Currently, right Axillary Artery cannulation and unilateral antegrade cerebral perfusion through the same cannula are preferred choices for acute type A aortic dissection repair. However, the existence of an aberrant right subclavian Artery can jeopardize cerebral perfusion through the right Axillary Artery cannula. In this study, we intended to explain the repair of acute type A aortic dissection using right Axillary Artery cannulation in a patient with aberrant right subclavian Artery.