Arterial Injury in the Upper Limb Resulting from Dog Bite.

Dog bites in the upper limbs have particular significance, because despite the small size of the puncture wounds, penetration is deep, causing serious injuries to deeper structures. There is currently very little data relating to upper extremity dog bite arterial injury. We present the case of a 32-year-old man who sustained a dog bite injury to his right arm, leading to direct puncture and spasm of the brachial artery. He was successfully treated with a jump bypass graft to the right brachial artery, with the use of the reversed ipsilateral cephalic vein as a conduit. We identified 34 cases in the literature reporting upper limb arterial injury secondary to dog bite. Twenty-two cases in the literature detailed axillobrachial artery damage (65%), 24% radial artery, 3% ulnar artery, and 9% combined. Presentation was most commonly with diminished pulses found in at least 45% of the patients. Arterial thrombosis occurred in 29% of cases of single artery injury, transection in 15%, intimal tear in 9% of cases, and undisclosed in 44%. Management most commonly included interposition graft (47%) and primary repair (20%), while 15% did not undergo surgical intervention, 9% underwent ligation, and 3% were treated with thromboembolectomy. Follow-up data for these patients are scarce, with some experiencing residual neurological deficit. This report highlights the importance of prompt recognition and treatment of vascular injury following dog bite to attain an optimal outcome and minimize complications.

Drug-eluting stents for the treatment of complex femoro-popliteal disease: a systematic review and meta-analysis.

INTRODUCTION: Endovascular methods have emerged as an appealing alternative to bypass for the treatment of patients not suitable for surgery. Drug eluting stents (DES) have been developed to address the limitations of angioplasty and stenting. There is a paucity of data in the literature on their performance for the treatment of patients with long femoro-popliteal segment lesions. We aimed to analyze the evidence supporting the use of DES in patients with complex femoro-popliteal disease. EVIDENCE ACQUISITION: A systematic review and meta-analysis was conducted according to the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. EVIDENCE SYNTHESIS: A total of 1255 potentially relevant articles were initially selected. After reviewing at title or abstract level, 22 articles were read in full and 10 were included. These studies reported on the use of DES for 1539 patients. In all studies the DES that was employed was a paclitaxel-eluting stent (Zilver PTX, Cook Medical; Bloomington, IN, USA). Average lesion length ranged from 114 mm to 400 mm. The pooled technical success rate was 0.964 (95% confidence interval [CI]: 0.936-0.980). The pooled estimate of limb loss at 12 months was 0.019 (95% CI: 0.012-0.030), stent fracture at 12 months was 0.035 (95% CI: 0.007-0.155), primary patency at 12 months was 0.705 (95% CI: 0.576-0.807) and secondary patency at 12 months was 0.898 (95% CI: 0.815-0.946). CONCLUSIONS: The short-term outcomes of DES for TASC C & D femoro-popliteal lesions are encouraging. Caution is advised in extrapolating the results of the included studies due to the large heterogeneity and lack of reporting of subgroup specific outcomes.

A Cadaveric Study of the Branching Pattern and Diameter of the Genicular Arteries: A Focus on the Middle Genicular Artery.

The aim of the study was to gain an appreciation of the variation in the branching pattern and diameter of the genicular arteries arising directly from the popliteal artery (PA), namely, the superior medial genicular artery (SMGA), superior lateral genicular artery (SLGA), inferior medial genicular artery (IMGA), inferior lateral genicular artery (ILGA), and middle genicular artery (MGA). Twenty cadaveric knees aged between 62 and 92 years were dissected. A posterior midline vertical incision was used to gain access to the PA. The diameter of the PA, the sequence of branching, and subsequent diameter of genicular vessels and common trunks were recorded. PA average diameter was 7.9 mm. The SMGA (1.6-mm diameter) was the first branch in 45% and the second branch in 20%, and in seven limbs it arose from a common trunk with the SLGA. The SLGA was the second branch in 30% and the first branch in 25%, and it branched from a common trunk in 45%. The MGA (1.1-mm diameter) arose as the second branch in four knees and as the third branch in eight knees. It arose from a common trunk in eight knees, either with a superior genicular (three knees) or with an inferior genicular (five knees). The IMGA (1.5-mm diameter) was the third branch in 25%, the fourth branch in 35%, and the fifth branch in 15%. In five cases, it arose from a common trunk (25%). The ILGA (1.4-mm diameter) was the third branch in 15%, the fourth branch in 30%, and the fifth branch in 25%. It arose from a common trunk in six knees. These trunks also gave rise to the IMGA in all cases. There is extensive variation in the branching pattern and diameter of the genicular arteries differing from textbook descriptions. An awareness of vascular variation is imperative for preservation of the blood supply to the knee, which may promote recovery after anterior cruciate ligament reconstruction and popliteal aneurysm repair.