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Complications of axillofemoral, femoral-femoral, and iliac-femoral grafts Diagnosis, Prevention, and Management
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Farah Mohammad, Mitchell Weaver
Upper extremity ischemia is fortunately a rare complication. Mawatri et al. describe a risk of 2.5% of their 25% of grafts that occluded.10 Kempczinski and Penn have also described arterial steal syndrome.11 Rashleigh-Belcher et al. describe three cases of axillary artery thrombosis. They believe the likely cause was sharp angulation or pulling down of the artery from graft tension.12 The residual stump of the proximal anastomosis of a non-functioning axillary femoral bypass graft may also be the source of arterial emboli to the distal ipsilateral upper extremity (Figure 26.1a, 26.1b, 26.1c); if this occurs, in addition to performing a thrombo-embolectomy of the upper extremity, the axillary anastomosis should be taken down and patch angioplasty of the artery performed to prevent further events.
Surface Anatomy
Published in Sarah Armstrong, Barry Clifton, Lionel Davis, Primary FRCA in a Box, 2019
Sarah Armstrong, Barry Clifton, Lionel Davis
Contents Axillary artery – main artery to the upper limb Three parts, all related to pectoralis minor (medial, posterior and lateral). Only the medial and posterior parts pass through the axillaAxillary vein – drains the arm via the cephalic and basilic veinsBrachial plexus – plexus of spinal nerves forming the peripheral nerves of the upper limbBiceps brachii and coracobrachialis – tendons attaching to the coracoid process of the scapulaAxillary lymph nodes
Upper Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The axillary vein is located within the axillary sheath, a connective tissue sleeve that also surrounds the axillary artery and the brachial plexus. The axillary artery (Figure 4.4) is the continuation of the subclavian artery; it begins at the lateral border of the first rib, and ends at the inferior border of the teres major where its name changes to brachial artery (”artery of the arm”). The easiest way to learn the branches of the axillary artery is to divide it into three parts: The first, second, and third parts lie medially, posteriorly, and laterally to the pectoralis minor muscle, respectively (Plate 4.9). Details about the specific muscles that the branches of the axillary artery supply are given in Tables 4.1 and 4.2. The first part of the axillary artery has one branch: the superior thoracic artery, which makes sense because this is the most medial—and thus superior—branch of the axillary artery and lies in the thoracic region, supplying mainly the first and second intercostal spaces.
Characteristics of four-limb blood pressure and brachial-ankle pulse wave velocity in Chinese patients with Takayasu arteritis
Published in Blood Pressure, 2022
Yang Chen, Hui Dong, Hong-Wu Li, Yu-Bao Zou, Xiong-Jing Jiang
All patients with TA underwent peripheral angiography (PAG), and most underwent computed tomography angiography (CTA); the severity of arterial lesions was recorded. The arteries of the superior arch, aorta, and lower extremities were segmented to determine the location, number, and degree of stenosis. According to PAG and CTA, the following Hata types [28] of TA were analysed: Type I (involvement of primarily the branches from the aortic arch), Type IIa (involvement of the ascending aorta, aortic arch), Type III (involvement of the thoracic descending aorta, abdominal aorta, and/or renal arteries), Type IV (involvement of only the abdominal aorta and/or renal arteries), and Type V (involvement of the ascending aorta, aortic arch with its branches and thoracic descending aorta combined with the abdominal aorta and/or renal arteries). Arterial stenosis was defined as a reduction in the diameter of the artery >50%. Stenosis of the subclavian artery (including the brachiocephalic trunk), axillary artery, and brachial artery was defined as upper limb artery stenosis. Stenosis of the artery from the bifurcation of the abdominal aorta to the left and right iliac arteries, femoral artery, and inferior genicular artery was defined as stenosis of the lower limb artery.
Alternative Access for Mechanical Circulatory Support
Published in Structural Heart, 2020
Mir B. Basir, Marvin H. Eng, Pedro Villablanca, Mark B. Anderson, Mohammad Zaidan, Dee Dee Wang, Khaldoon Alaswad, William W. O’Neill, Mohammad Alqarqaz
Individual case series have targeted different segments of the axillary artery for percutaneous access. Some have accessed the AxA in the first segment27,30; while others have accessed the AxA in the third segment of the vessel.32,35 Both locations have reported high procedural success and low complications rates. Based on the proximity to the brachial plexus we typically aim, similar to other groups,34 to access the AxA within the distal portion of the first segment or within the second segment, i.e. through the pectoralis minor muscle. This part of the artery has less side branches when compared to the distal vessel; is located lateral to the rib cage (extra-thoracic) thus potentially decreasing the risk of pneumothorax; and if manual compression is required the artery can be compressed against the rib cage at this location. Avoiding the distal segment may also decrease risk of brachial plexus injury which is located anterior to the AxA in its distal segment.36 This first portion of the axillary artery is also larger than the distal segment.
The Safety and Efficacy of a Minimalist Approach for Percutaneous Transaxillary Transcatheter Aortic Valve Replacement (TAVR)
Published in Structural Heart, 2020
Yumiko Kanei, Waqas Qureshi, Nirmal Kaur, Jennifer Walker, Nikolaos Kakouros
Direct percutaneous transaxillary access was obtained with the arm abducted at 45º under direct ultrasound and fluoroscopic guidance with the use of a micropuncture system and modified Seldinger technique (Figure 1b,c). We aim to obtain access at the very distal end of the first part of the axillary artery, just proximal to the lateral thoracic artery, identified using ultrasound guidance. Depending on the anatomy, access just distal to this branch may also be obtained to allow sufficient distance between the access site and the subclavicular portion of the vessel, so as to facilitate open surgical repair if needed and manual compression of the proximal segment of the artery against the second rib. Two Perclose Proglide™ closure devices (Abbott Vascular, Abbott Park, IL, USA) were placed for preclosure, and an 8Fr sheath was inserted. Manual pressure proximal to the access site was applied during exchanges.