Ulus Travma Acil Cerrahi Derg. 2007; 13(2): 145-148

Aksiller arterin künt travmaya baðlý izole hasarlanmasý

Mehmet Öç, Murat Güvener, H. Ýbrahim Uçar, Birkan Akbulut, Mustafa Yýlmaz, Ünsal Ersoy
Hacettepe Üniversitesi Týp Fakültesi, Kalp-damar Cerrahisi Anabilim Dalý, Ankara, Türkiye

Kemik, brakiyal pleksus, ven ve yumuþak doku hasarý olmadan ani ve tek künt travmaya baðlý olarak aksiller arterin intimal hasarý çok nadirdir. Arteriyel yaralanmanýn kalýcý hasar býrakmamasý için erken taný ve uygun tedavi gereklidir. Klinik belirtiler genelde belli belirsizdir ve kollateral dolaþýma baðlý olmak üzere yaralanma sonrasý, uzun iskemik dönem geçtikten sonra belirginleþmektedir. Yirmi yaþýndaki erkek hasta, kolu hiperabdüksiyon ve hiperekstansiyon pozisyonda buzdolabý taþýrken sol kolunu incinme ve bundan 1,5 ay sonra sol kolundaki aðrý ve uyuþukluk þikayetleriyle baþvurdu. Hastanýn hastaneye yatýþýndan sonra yapýlan aksiller arter dijital substraksiyon anjiyografisinde aksiller arterin oklüzyonu izlendi ve oklüzyonun distalinde kollaterallerle dolum gözlenmedi. Ameliyatta, aksiler ve brakiyal arter safen ven ile baypas edildi. Üst ekstremitenin künt travmasýnýn erken döneminde kollateral dolaþým nedeniyle vasküler yetersizlik distal nabýzlar olsa bile tanýnamayabilmekte ve üst ekstremitenin anjiyografisi doðru taný ve tedavi için kaçýnýlmaz olmaktadýr. Bu olgu bizim ikinci tecrübemizdir; birinci olgudaki tecrübemize dayanarak bu olguda olduðu gibi kronik durumlarda revaskülarizasyon sonrasý greft trombozu söz konusuysa oral antikoagülasyona en az altý ay devam edilmesi gerektiðini düþünmekteyiz.

Anahtar Kelimeler: Aksiller arter/yaralanma, künt travma; uzun iskemik dönem.

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Isolated axillary artery injury due to blunt trauma

Mehmet Öç, Murat Güvener, H. Ýbrahim Uçar, Birkan Akbulut, Mustafa Yýlmaz, Ünsal Ersoy
Department Of Thoracic And Cardiovascular Surgery, Hacettepe University, Faculty Of Medicine, Ankara, Turkey

The intimal damage of the axillary artery due to an acute, single blunt trauma is very rare without concomitant bone, brachial plexus, venous and soft tissue injuries. Early diagnosis and appropriate management of the arterial injury is essential to avoid permanent disability. The clinical signs are usually occult and do not become manifest until a long ischemic interval following injury, owing to the extensive collateral network. A twenty-year-old male patient had injured his left arm in a hyperabduction and hyperextension position while he was carrying a refrigerator with his arm. An increase in the intensity of pain and numbness reappeared in his left arm 1.5 months after the trauma. Digital subtraction angiography of the axillary artery performed after his hospitalization showed an occlusion of the axillary artery and no reconstitution of distal part of the occlusion via collateral vessels. During the operation, the axillary and brachial arteries were bypassed with a saphenous graft. As shown in this case report, in the early period after blunt trauma of the upper limb, progressive signs of vascular compromise may disappear because of collateral circulation even if the distal pulses are absent. Then an angiography of the upper limb becomes essential for correct diagnosis and treatment. This is our second experience. On the basis of our first experience that was reported, in such a chronic case, oral anticoagulation must be carried out at least six months whenever a graft thrombosis after revascularization is encountered.

Keywords: Axillary artery/injuries, blunt trauma; long ischemic interval.

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