Brachial Artery Injuries Operative Management and Predictors of Outcome

Juan A. Asensio, John J. Kessler, Stephanie S. Miljkovic, Tharun R. Kotaru, Parinaz J. Dabestani, Louay D. Kalamchi, Florian A. Wenzl, Arthur P. Sanford, Vincent L. Rowe

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Abstract

Background: Brachial artery injuries are rare. The objectives of the study are to report our experience and identify predictors of outcome. The hypothesis of the study is that maintaining ischemic times less than six hours results in improved outcomes. Methods: This is a retrospective 118-month study. The outcome measure is total operative time from admission to restoration of blood flow, and outcomes are survival and limb salvage. Statistical analyses used in the study are univariate and multivariate stepwise logistic regression. Results: There were 124 patients with 131 brachial artery injuries. Mechanism of injury (MOI) included the following: penetrating: 108 (87%) and blunt: 16 (13%). Operative management included the following: 77 (62%) reverse saphenous vein interposition grafts, 37 (29.8%) end-to-end anastomosis, and 4 (3.2%) ligation. Fasciotomies were performed in 23 (19.2%) patients. Outcomes of the study were as follows: 120 patients survived and the overall survival rate was 96.8%, adjusted survival rate excluding intraoperative deaths was 100%, overall limb salvage/amputation rate was 95.1%/4.9%, and adjusted limb salvage/amputation rates excluding intraoperative deaths were 98.3%/1.67%. Univariate analysis showed the mean ischemic times for survivors as 5 ± 3.1 hrs (300 ± 186 min) versus ischemic times for non survivors as 3 ± 2.2 hrs (180 ± 132 min) (P = 0.017); Injury Severity Score (ISS) (P = 0.002); and estimated blood loss (EBL) (P = 0.024). Logistic regression identified independent predictors of outcome for survival: MOI: penetrating [P = 0.015, RR – 4.29, 95% CI: 1.49–12.36]; Glasgow Coma Score < 7 [P < 0.001, RR – 21.71, 95% CI: 9.37–50.32]; ISS > 15 [P < 0.005, RR – 4.98, 95% CI: 1.68–14.73]; and patients not requiring ED thoracotomy [P = 0.009, RR – 7.48, 95% CI: 2.58–21.69]. Conclusions: Brachial artery injuries are rare. For patients not requiring ED thoracotomy, Glasgow Coma Score, ISS, and EBL predicted survival. The adjusted limb salvage rate was 98.3%. Patients with brachial artery injuries die from associated injuries, experiencing less ischemic times than survivors who are able to undergo repairs.

Original languageEnglish (US)
JournalAnnals of Vascular Surgery
DOIs
StateAccepted/In press - 2020

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

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    Asensio, J. A., Kessler, J. J., Miljkovic, S. S., Kotaru, T. R., Dabestani, P. J., Kalamchi, L. D., Wenzl, F. A., Sanford, A. P., & Rowe, V. L. (Accepted/In press). Brachial Artery Injuries Operative Management and Predictors of Outcome. Annals of Vascular Surgery. https://doi.org/10.1016/j.avsg.2020.05.049