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Vascular Trauma
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
Now you explore the right arm wound. You can see the brachial artery has been lacerated over a distance of 4 cm. It is not transected, but it is heavily damaged and definitely could not be repaired using a simple prolene suture. This would need an interposition graft repair. You extend your incision proximally and control the brachial artery a few centimetres above the injury. You can also see that the cephalic and antecubital vein have been transected.
Crossing challenging lesions
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Axillary and/or brachial artery occlusions are unusual. An occlusion might occur as a result of trauma (humerus fracture or dislocation) or extrinsic compression from the first rib. The approach is usually antegrade with the sheath tip placed in the subclavian or axillary artery. Stents are used sparingly due to the highly mobile nature of the artery.
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
Having learned the branches of the axillary artery, it becomes much easier to understand the configuration of the arm and forearm arteries. The continuation of the axillary artery that enters the arm to provide supply to all the arm, forearm, and hand muscles is the brachial artery, which runs on the anterior side of the arm (Plate 4.3). If the body were free from evolutionary and developmental constraints, it would be more logical to have two major arteries, one for each of the two compartments of the arm (anterior and posterior). As this is not the case, the brachial artery has to perform a “trick” to supply to the triceps brachii and the other tissues of the posterior arm: It sends a proximal branch into the posterior arm compartment, as the deep brachial artery (or deep artery of the arm, or profunda brachii artery) (Figure 4.4). This artery courses around the posterior surface of the humerus, where it accompanies the radial nerve in the spiral (radial) groove, and then gives rise to the radial collateral artery that anastomoses with the radial recurrent artery branching from the radial artery (Plate 4.9b). The brachial artery then branches again, more distally, in the middle third of the arm, to give rise to the superior ulnar collateral artery and the inferior ulnar collateral artery. These two collateral arteries anastomose, respectively, with the posterior ulnar recurrent artery and the anterior ulnar recurrent artery branching from the ulnar artery.
High-frame-rate A-mode ultrasound for calibration-free cuffless carotid pressure: feasibility study using lower body negative pressure intervention
Published in Blood Pressure, 2022
Kiran V Raj, P. M. Nabeel, Dinu Chandran, Mohanasankar Sivaprakasam, Jayaraj Joseph
Blood pressure (BP) measured at the brachial artery using a cuff is the most widely practiced and clinically accepted method for BP estimation. Several recent studies have underlined the prognostic and therapeutic significance of BP measured from the central arterial system (central blood pressure [CBP]). Pulsatile components of arterial pressure are indeed not comparable across different arterial sites owing to pulse pressure (PP) amplification [1]. Discrepancies also exist in CBP values among subjects with identical brachial BP, and therefore, the peripheral measures are not always a surrogate of the central ones [2,3]. In this regard, CBP independently reflects the actual load on the heart and other target organs, with better implications than the brachial BP [4–6]. Compared to the brachial BP, CBP is more closely related to the carotid intima-media thickness, left ventricular mass index and pulse wave velocity (PWV) [2]. Studies have recognized the differential influence of various anti-hypertensive drugs on central and peripheral BP parameters [2]. It has become increasingly evident over the last decade that CBP holds superior predictive value concerning cardiovascular events [2–4].
Amplatzer Post-Infarction Ventricular Septal Defect Closure via Retrograde Transarterial Access: Easier and Better
Published in Structural Heart, 2021
David Hildick-Smith, Natalia Briceno, Osama Alsanjari, Gerald J. Clesham, Thomas Keeble, Andrew Hill, Arionilson Gomes, James Cockburn
The right brachial artery measured 5 mm diameter. The right axillary artery measured 7 mm diameter, and we, therefore, used an ultrasound-guided percutaneous axillary approach, as for transcatheter aortic valve implantation.4 After induction of anesthesia and insertion of a TOE probe, two Proglide sutures were placed and a 14 F 30 cm Cook sheath was introduced. The defect was crossed directly with a pigtail catheter up into the left pulmonary artery. An Amplatzer superstiff wire was placed and we were rapidly ready therefore for implantation of the device. We took the 24 mm PIVSD device (maximum diameter 36 mm) and placed it along the length of the tract (Figure 5a and Figure 5b). The device conformed well, and there was only trivial remaining color flow Doppler from left to right (Figure 5c). Systemic pressure rose 20 mmHg on device release.
Effectiveness of the short-term use of Cimicifuga racemosa in the endothelial function of postmenopausal women: a double-blind, randomized, controlled trial
Published in Climacteric, 2020
E. S. Fernandes, M. F. S. Celani, M. Fistarol, S. Geber
All women had their blood pressure taken and the brachial artery was identified medially in the antecubital fossa of the dominant upper limb. An image of the vessel was obtained ∼5 cm from the elbow of the upper limb, and a longitudinal cut was made (mode B) at the moment the vessel was least distended, which corresponds to cardiac diastole, obtained by recovery of images through the equipment’s Cine Loop. The image was frozen to obtain the mean of the three measurements of the vessel caliber (D1). Following this initial measurement, the cuff of the sphygmomanometer, placed proximal to the site of the brachial artery measurement, was inflated for 5 min to a pressure >250 mmHg and subsequently slowly deflated. The mean of three further measurements of vessel size was obtained by the same technique as already described, 1 min after the cuff was deflated (D2). The FMD value was obtained using the formula: FMD (%) = [(D2 – D1) / D1] × 100, where D1 = diameter at baseline and D2 = diameter post occlusion.