Management of arm arterial injuries

Abstract

Management, morbidity, and mortality of arterial injuries of the arm are dependent upon site of injury, promptness and accuracy of diagnosis, and involvement of contiguous structures. To determine results and establish principles of management, a retrospective analysis was undertaken of 109 arm arterial injuries from the thoracic inlet to the wrist in 102 patients. Iatrogenic injuries were excluded. Arterial injuries were classified into those affecting the upper arm (subclavian, axillary, and brachial) and those affecting the lower arm (radial, ulnar, and interosseous). This proved to be a useful classification because of differences in management and results at these two levels. Thirty-six or one third of injuries involved the upper arm (13 subclavian, seven axillary, and 16 brachial) and 73 involved the lower arm (30 radial, 29 ulnar, 12 radioulnar, and two interosseous). Of the 19 individuals in hypovolemic shock when first examined, 12 (63%) had sustained upper arm injuries. Fifty-four percent of all patients had nerve involvement when initially examined, the majority (76%) sustaining lower arm injuries. Vein grafts were required during 19 repairs whereas resection and end-to-end repair were successful on 62 occasions. No synthetic grafts were used. Ligation alone was performed 18 times, only among those with lower arm injuries. Two patients died, both of hypoxic brain damage. Twenty-eight percent of patients suffered late disability despite an adequate vascular repair. Overall, 7% of patients with upper arm injuries and 21% of those with lower arm injuries were disabled when last seen. Upper arm arterial injuries are more of a threat to life than are lower arm injuries, but lower arm arterial injuries are more disabling, mainly because of associated nerve involvement.