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Complications of stenting for occlusive disease of aortic arch branches
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Christopher A. Latz, Mark F. Conrad
Arterial access is typically obtained via the transfemoral or the transbrachial route depending on the planned intervention. The transfemoral approach has traditionally been preferred to reach the carotid arteries; however, with severe ostial lesions, there is no room to place a sheath in the artery which can lead to an unstable system. In this situation, access via open exposure of the carotid artery may be the best way to treat a proximal lesion and protect the brain from an embolic shower during angioplasty and stenting. This is especially true when the patient has tandem severe lesions at the ostia of the common carotid and at the carotid bifurcation.6 Brachial access provides an attractive alternative for treating subclavian and innominate lesions, especially flush occlusions, which would be difficult to select from the aorta. For brachial access, the arm is placed straight out with the hand supinated. The artery can be accessed just above the antecubital fossa. Here it passes under the bicipital aponeurosis and traverses the medial aspect of the arm just below the long head of the biceps brachii muscle and can be compressed against the humerus once the procedure is complete. Access is best obtained under ultrasound guidance with a micropuncture needle to avoid injury to the median nerve, which lies in close proximity to the brachial artery. Finally, radial access for supra-aortic trunk intervention has also been described and is becoming more popular due to a perceived decrease in complications.7
Upper Extremity Arterial Occlusive Disease
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
Emboli of cardiac origin can be readily removed by exposure of the distal brachial artery and its bifurcation via a longitudinal skin incision just distal to the elbow crease in the proximal forearm. The median nerve is in close proximity and should be kept out of harm’s way. Division of the bicipital aponeurosis facilitates exposure. An adequate length (2-3 cm) of the artery is dissected and the vessel is looped to allow for proximal and distal control.
The Pericardium (PC)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Bicipital aponeurosis or lacertus fibrosus: This triangular, membranous band forms a distal continuation of the biceps brachii muscle. It courses from the biceps tendon, across the cubital fossa, to blend with the deep antebrachial fascia, blanketing the flexor muscles of the forearm. The proximal end of the lacertus fibrosus, closer to the biceps tendon, is palpable as it courses obliquely over the brachial artery and median nerve. The lacertus protects this neurovascular couple from trauma; it also dissipates load away from the biceps tendon entheses, reducing pull on the radial biceps tendon.1
Evaluation of function following rehabilitation after distal biceps tendon repair
Published in European Journal of Physiotherapy, 2020
Maria Liljeros, Monika Fagevik Olsén, Gunilla Kjellby Wendt
Distal biceps tendon rupture is an uncommon injury, which most often affects men aged 40–60 and constitutes 3% of all biceps ruptures. The injury incidence is 1.2/100,000/year and often occurs due to an eccentric force to a supinated and flexed elbow [1–3]. The biceps brachii is the most superficial and prominent muscle in the anterior compartment of the arm. It has two heads and crosses over both the shoulder and elbow joints. The long head originates from the supraglenoid tubercle, and the short head from the coracoid process of the scapula [4]. Together they insert distally to the radial tuberosity and into the deep fascia of the forearm via the bicipital aponeurosis (also called lacertus fibrosus). The biceps brachii is the most powerful supinator and flexor of the elbow, a rupture will therefore affect the elbow with reduced strength in both supination and flexion [1,4,5]. Possible causes of distal biceps tendon rupture are vascular, degenerative and mechanical, or an inflammation in the biceps radial bursa [1,5,6].
Brachial distal biceps injuries
Published in The Physician and Sportsmedicine, 2019
Drew Krumm, Peter Lasater, Guillaume Dumont, Travis J. Menge
The biceps brachii muscle is made up of a short head and a long head. The short head originates on the coracoid process, while the long head originates on the supraglenoid tubercle. They each insert on the radial tuberosity. This muscle’s main action is to supinate the forearm, but it also assists in elbow flexion. Since the short head has a more distal attachment on the tuberosity than the long head, it is a greater contributor to elbow flexion. The long head attaches to the apex of the tuberosity and is a greater contributor to supination than the short head. The biceps is innervated by the musculocutaneous nerve and receives its blood supply from branches of the brachial artery. On clinical exam, the distal biceps tendon may be mistaken for the lacertus fibrosus, also known as the bicipital aponeurosis, which originates from the short head of the biceps and helps protect the neurovascular bundle in the antecubital fossa. The lateral antebrachial cutaneous nerve (LABCN), which is the terminal cutaneous branch of the musculocutaneous nerve, is at risk for injury in operative repair of distal biceps avulsion injuries. It is located between the biceps and brachialis muscles and pierces the deep fascia just lateral to the distal biceps tendon. The nerve is located in the subcutaneous tissue of the antecubital fossa and supplies sensation to the lateral aspect of the forearm. The radial nerve is also at risk for injury. The radial nerve is located between the brachioradialis and brachialis near the distal humerus. It bifurcates into the posterior interosseous nerve and radial sensory nerve in the antecubital fossa [6].
Management of posterior interosseous nerve (PIN) palsies after distal biceps tendon repair using a single incision technique- a conclusive approach to diagnostics and therapy
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Inga S. Besmens, Marco Guidi, Andreas Schiller, David Jann, Pietro Giovanoli, Maurizio Calcagni
Musculus biceps brachii: The biceps brachii muscle arises with two heads proximally from the supraglenoid tubercle of the scapula and the coracoid process of the scapula. Distally the muscle inserts in a tendinous footprint on the radial tuberosity after giving of the lacertus fibrosus or bicipital aponeurosis which fans out in an ulnar direction before merging with the superficial fascia of the ulnar side of the forearm [5]