A retrospective review of brachial artery injuries and repairs--is it still a "training artery"?

BACKGROUND

A retrospective analysis of operatively managed brachial artery injuries spanning a five-year period from January 2003 to December 2007.

METHODS

The medical records of all patients who had operative management of brachial artery injuries were reviewed. Demographic data, mechanism of injury, pathology of injury, associated injuries, duration of injury, operative management and outcomes were analysed.

RESULTS

A total of 115 patients were included in the review. Twelve patients (10.4%) were female and 103 (89.6%) were male. The mean age was 27.3 years with the oldest patient being 70 years and the youngest 13 years. Most of the injuries were caused by stabs to the brachial artery (53%). 33% were due to gunshot wounds, 11.3% were due to blunt trauma and 2.9% were due to other mechanisms of injury. The majority of injuries (58.3%) were repaired with a reverse saphenous vein graft. Most patients had a pulse restored on discharge with only 4.4% of repairs occluding and of the repairs that occluded only one patient needed an ablation. Four patients (3.5%) had an ablation due to a non-viable limb. 13.9% of patients had a fasciotomy, 54.8% had an associated peripheral nerve injury and 14.8% had an associated venous injury.

CONCLUSION

Brachial artery injuries are still common in our practice, with most being managed operatively. Due to the good collateral circulation in the arm, most brachial artery injuries do not result in limb loss even with a significant time delay and even when the repair occludes. Brachial artery injuries are thus a good vessel for surgical registrars to train on.