True Idiopathic Brachial Artery Aneurysm Treated With a Saphenous Vein Graft.

Purpose: The objective of this study is to report a case of a 65-year-old woman who presented with pallor and pain of her left arm secondary to a true arterial brachial aneurysm, which was successfully treated with saphenous vein bypass and embolization of the aneurysm sac. A review of the literature is also presented. Case report: A 65-year-old woman presented with an acute onset of pallor and pain of her left forearm, and hand. On physical examination, there was a pulsatile mass at the forearm. A doppler ultrasound showed a fusiform aneurysmal dilatation of the brachial artery of 23 mm of diameter. A dynamic contrast-enhanced MRI angiogram confirmed a fusiform dilation of the distal brachial artery. The patient was scheduled for open repair. A fusiform 20 x 60 mm aneurysm of the distal brachial artery extending to the cubital fossa was found and a brachial artery to radial and ulnar arteries bypass with interposed reverse right saphenous vein was created. Embolization of the aneurysm sac was performed using Gelita-spon ® (Gelita Medical, Eberbach, Germany). A final angiogram showed an adequate perfusion through the bypass to the hand, and no contrast in the aneurysmal sac. Postoperative course was uneventful with discharge on the fourth postoperative day. Conclusion: Revascularization with autologous saphenous vein graft and exclusion of the aneurysm with local embolization is a good treatment alternative in a patient with symptomatic brachial aneurysm with distal embolization.

Damage control of peripheral vascular trauma - Don't be afraid of axillary or popliteal fosses.

Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient's life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed post-operatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.

El trauma vascular periférico no es común en el contexto civil, pero representa una amenaza para la vida del paciente o de la extremidad. El control definitivo de la lesión vascular representa un desafío quirúrgico, especialmente en pacientes con inestabilidad hemodinámica. Este artículo describe la propuesta de manejo del trauma vascular periférico de acuerdo con los principios de la cirugía de control de daños. Se debe identificar los signos sugestivos de lesión vascular y realizar oportunamente maniobras temporales para el control del sangrado. Se debe elegir el abordaje quirúrgico dependiendo del área anatómica lesionada. Se proponen dos nuevas incisiones para acceder a la región axilar y poplítea. La prioridad es restablecer la perfusión de la extremidad mediante el reparo primario o técnicas de control de daños (shunt vascular o abordaje endovascular). Los pacientes sometidos a cirugías vasculares mayores deben ser manejados postoperatoriamente en la unidad de cuidados intensivos para corregir las alteraciones fisiológicas e identificar aquellos que desarrollen un síndrome compartimental. Todos los procedimientos vasculares permanentes o temporales deben contar con un reparo definitivo en las primeras 8 horas. El diagnóstico temprano e intervención oportuna son fundamentales para salvaguardar la perfusión y funcionalidad de la extremidad.

Sleeve Fistulectomy: A Novel Hybrid Technique to Manage the Degenerative Arteriovenous Fistula.

Aneurysmal degeneration following long-term access is an important problem associated with an arteriovenous fistula (AVF) and can result in rupture, thrombosis, or the need for ligation. We describe five patients receiving hemodialysis through large degenerative brachiocephalic AVFs who underwent successful revision and avoided the need for a temporary dialysis catheter. A hybrid approach using an open surgical technique with both endovascular and laparoscopic tools provides an opportunity to maintain patency and restore function by combining modern surgical tools.

Outcomes of a Polytetrafluoroethylene Hybrid Vascular Graft with Preloaded Nitinol Stent at the Venous Outflow for Dialysis Vascular Access.

BACKGROUND: To evaluate outcomes and patency of arteriovenous grafts (AVGs) created using Gore hybrid vascular grafts in hemodialysis patients with limited venous outflow or challenging anatomy. MATERIALS AND METHODS: A retrospective review was performed in two academic centers of all patients between July 2013 and December 2016 who underwent surgical AVG creation using a Gore hybrid vascular graft in a brachial artery to axillary configuration. Patient characteristics and comorbidities as well as graft patency, function, and subsequent need for percutaneous interventions were recorded. RESULTS: Forty-six patients including 30 females (65.2%) and 16 males (34.8%) with a mean age of 63 ± 13 years were identified. The most common indications for a hybrid vascular graft were limited surgical accessibility and/or revision of existing AVG due to severe stenotic lesions at the venous outflow in 33 patients (72%). One-year primary unassisted and assisted patency rates were 44 ± 8% and 54 ± 8%, respectively, compared with 1-year secondary patency rate of 66 ± 8%. The rate of percutaneous interventions to maintain graft function and patency was approximately one intervention per graft per year. CONCLUSIONS: Access created with the hybrid vascular graft in a brachial-axillary (brachial artery to axillary vein) configuration is an acceptable option for patients with limited venous outflow reserve and challenging anatomy. Twelve-month primary and secondary patency rates and need for percutaneous interventions were comparable to traditional AVGs.

Transcatheter anastomosis connector system for vascular access graft placement: results from a first-in-human pilot study.

PURPOSE: A lengthy healing and maturation period follows standard surgical preparation of a permanent arteriovenous access, often requiring or extending use of a venous catheter (VC) for hemodialysis. The InterGraft™ Anastomotic Connector System was developed for minimally invasive anastomosis of an arteriovenous graft (AVG). The venous and arterial InterGraft™ connectors are designed to provide optimized flow dynamics and may result in reduction of AVG stenosis. This pilot study evaluated placement procedure success, patency and safety of the InterGraft™ connectors. METHODS: Nine AVGs were implanted in nine patients currently receiving dialysis with a VC. The study allowed use of both connectors (n = 5) or use of the venous connector with a sutured arterial anastomosis (n = 4). Monthly ultrasound examinations were performed throughout the six-month follow-up. AVG angiography was performed at five months. Endpoints included procedure success (acceptable graft flow at end of procedure, without significant bleeding or need for emergent surgery), patency, and device-related major adverse events. RESULTS: Procedure success was attained in all patients. AVGs were used for dialysis within 17 days, on average, and VCs were removed. Three patients exited the study early for reasons unrelated to the InterGraft™ connectors. The remaining six patients had patent grafts: two with assisted and four with unassisted patency. AVG flow rates were greater than 1 L/minute. No dilatations or aneurysms were observed by angiography. There were no device-related major adverse events. CONCLUSIONS: The InterGraft™ connectors can be safely and successfully used for AVG anastomoses, with acceptable near-term patency. Further clinical evaluation is warranted.

Alternative grafts for brachioaxillary hemodialysis access: 1-year comparative results

BACKGROUND: Many chronic renal patients lack autologous veins in the upper limbs suitable for construction of arteriovenous fistulas for hemodialysis. Alternative fistula options for these patients should be evaluated and compared.OBJECTIVE: To compare different types of grafts used for brachioaxillary access in hemodialysis patients in terms of their patency and complication rates.METHOD: Forty-nine patients free from arterial system abnormalities and with no venous options for creation of arteriovenous fistulae in the arm and/or forearm underwent brachioaxillary bypass with implantation of autologous saphenous vein, polytetrafluoroethylene (PTFE), or PROPATEN(r) grafts. Patients were assessed by Doppler ultrasonography at 3, 6, and 12 months after surgery. RESULTS: The four first saphenous vein grafts had failed by 3 or 6 months after surgery. The autologous saphenous vein group was discontinued at the beginning of the study because of extreme difficulty in achieving puncture and hematoma formation. Failure rates of PTFE and PROPATEN(r) grafts did not differ after 3 (p = 0.559), 6 (p = 0.920), or 12 months (p = 0.514). A log-rank test applied to cumulative survival of grafts at 1 year (0.69 for PTFE, 0.79 for PROPATEN(r)) detected no significant differences (p = 0.938). There were no differences in complications resulting in graft failure between the two types of prosthetic graft.CONCLUSION: Autologous saphenous vein grafts do not appear to be a good option for brachioaxillary hemodialysis access because of difficulties with achieving puncture. Brachioaxillary fistulae constructed using PTFE or PROPATEN(r) grafts exhibited similar patency and complication rates. Further studies with large samples size are warranted to confirm our findings.

CONTEXTO: Há inúmeros pacientes renais crônicos sem veias autólogas nos membros superiores para confecção de fístulas arteriovenosas para realização de hemodiálise. As opções de fístula nestes pacientes devem ser avaliadas e comparadas.OBJETIVO: Comparar diferentes enxertos para acesso braquioaxilar em pacientes hemodialíticos, em relação a permeabilidade e taxas de complicação. MÉTODO: Um grupo de 49 pacientes, sem alterações no sistema arterial e sem opções venosas para criação de fístula arteriovenosa no braço e/ou antebraço, foi submetido a procedimentos cirúrgicos para implante de diferentes enxertos: veia safena autóloga, enxertos de PTFE e PROPATEN(r).RESULTADOS: Os quatro primeiros implantes de veia safena falharam no terceiro e no sexto mês após a cirurgia. Interrompeu-se o uso de veia safena autóloga no início do estudo pela extrema dificuldade de punção e pela formação de hematoma. Não houve diferenças nas taxas de falha dos enxertos de PTFE e PROPATEN(r) após três (p = 0,559), seis (p = 0,920) e 12 meses (p = 0,514) de seguimento. O teste de Logrank aplicado à sobrevida cumulativa dos enxertos por um ano (0,68 para PTFE; 0,79 para PROPATEN(r)) não relevou diferenças (p = 0,938). Não foram encontradas diferenças entre os enxertos prostéticos em relação ao tipo de complicação que determinou as falhas.CONCLUSÃO: O enxerto de veia safena autóloga parece não ser é uma boa opção para acesso braquioaxilar em hemodialíticos, já que implica em dificuldade na punção. Os enxertos de PTFE e PROPATEN(r) em fistula braquioaxilar resultaram em permeabilidade e taxas de complicações similares. Estudos com amostras maiores são necessários para confirmar nossos achados.

Anomalous origin of the deep brachial artery (profunda brachii) observed in bilateral arms: case report / Origem anômala da artéria braquial profunda (profunda brachii) observada em braços bilaterais: relato de caso

During an ordinary dissection, a cadaver showed a bilateral anomalous origin of the deep brachial artery, where this vessel appeared like a branching of the subscapular artery with common trunk, which included the posterior circumflex humeral artery. The course and distribution of the deep brachial artery in the back compartment were relatively consistent with previous reports. Arterial variations can be damaged through iatrogenic means if not properly documented. The knowledge of this case is very important in clinical medicine and in surgeries in this compartment to prevent any injury.

Durante dissecação em prática usual, um cadáver apresentou origem anômala da artéria braquial profunda, na qual este vaso apareceu como um ramo da artéria subescapular com um tronco comum, que incluiu a artéria circunflexa posterior do úmero. O curso e a distribuição da artéria braquial profunda no compartimento posterior foram relativamente coincidentes com relatos prévios. Variações arteriais podem ser danificadas de maneira iatrogênica se não forem adequadamente documentadas. O conhecimento desse caso é muito importante na prática clínica e em cirurgias nesse compartimento para prevenção de qualquer injúria.

Cateterismo cardíaco por acceso radial percutáneo en pacientes con disección humeral previa / Transradial percutaneous approach for cardiac catheterization in patients with previous brachial artery cutdown

La punción percutánea de la arteria radial para la realización de procedimientos por cateterismo ha ganado mayor aceptación en los últimos tiempos. Esto sucedió como consecuencia de haber alcanzado resultados similares a los obtenidos mediante el acceso femoral, con los beneficios de una menor tasa de complicaciones y mayor confort de los pacientes. Recientemente, su utilización tomó un impulso adicional, por estar asociada a mejor pronóstico en síndromes coronarios agudos. En el presente trabajo hemos evaluado si la factibilidad, resultados y ventajas relacionadas al acceso percutáneo de la arteria radial en procedimientos por cateterismo, se aplican también a quienes presentan disección previa de la arteria humeral. Sobre un total de 1 356 accesos radiales percutáneos, 53 fueron en pacientes con disección previa de la arteria humeral, obteniéndose éxito del acceso en el 96.2% (51/53) de las punciones. A través de estos accesos se realizaron 71 procedimientos por cateterismo, con 93.6% (44/47) de éxito del procedimiento en las intervenciones diagnósticas y 100% (24/24) en las terapéuticas. En este grupo no ocurrieron complicaciones mayores. Las complicaciones menores sucedieron en el 1.4% (1/71) de los casos y no se registraron nuevas complicaciones en el seguimiento a siete días. Si bien el grupo es pequeño, consideramos que resulta suficiente para mostrar que las punciones percutáneas de la arteria radial para la realización de procedimientos por cateterismo, en pacientes con disección previa de la arteria humeral, son factibles y permiten elevadas tasas de éxito con baja frecuencia de complicaciones.

The percutaneous punction of the radial artery for catheterization procedures has gained acceptance lately. This was a consequence of achieving results similar to the femoral approach, with the benefits of a lower rate of complications and increased comfort for the patients post procedure. Recently it has gained an additional impulse with the better prognosis obtained in acute coronary syndromes. In this trial we have evaluated if the feasibility, results and advantages related with the use of the radial artery percutaneous approach to perform catheterization procedures, continues when used in patients who have had a previous brachial artery cutdown. Out of a total of 1356 percutaneous radial accesses, 53 were in patients with previous brachial artery cutdown. Through this access 71 catheterization procedures were performed, achieving access success in 96.2% (51/53) of the punctions. Once the access success was obtained, 93.6% (44/47) of the diagnostic procedures and 100% (24/24) of the therapeutics procedures were successful. During hospitalization, in this group of patients, no major adverse cardiac events occurred and there was a 1.4% (1/71) rate of minor events. At seven days follow up, no new complications were recorded. Although this is a small group, we believe that it is enough to show that percutaneous punctions of the radial artery to perform catheterization procedures, in patients with previous brachial artery cutdown, are feasible, allowing high access and procedure success rates, with a low frequency of complications.

Cateterismo cardíaco por acceso radial percutáneo en pacientes con disección humeral previa / Transradial percutaneous approach for cardiac catheterization in patients with previous brachial artery cutdown

La punción percutánea de la arteria radial para la realización de procedimientos por cateterismo ha ganado mayor aceptación en los últimos tiempos. Esto sucedió como consecuencia de haber alcanzado resultados similares a los obtenidos mediante el acceso femoral, con los beneficios de una menor tasa de complicaciones y mayor confort de los pacientes. Recientemente, su utilización tomó un impulso adicional, por estar asociada a mejor pronóstico en síndromes coronarios agudos. En el presente trabajo hemos evaluado si la factibilidad, resultados y ventajas relacionadas al acceso percutáneo de la arteria radial en procedimientos por cateterismo, se aplican también a quienes presentan disección previa de la arteria humeral. Sobre un total de 1 356 accesos radiales percutáneos, 53 fueron en pacientes con disección previa de la arteria humeral, obteniéndose éxito del acceso en el 96.2% (51/53) de las punciones. A través de estos accesos se realizaron 71 procedimientos por cateterismo, con 93.6% (44/47) de éxito del procedimiento en las intervenciones diagnósticas y 100% (24/24) en las terapéuticas. En este grupo no ocurrieron complicaciones mayores. Las complicaciones menores sucedieron en el 1.4% (1/71) de los casos y no se registraron nuevas complicaciones en el seguimiento a siete días. Si bien el grupo es pequeño, consideramos que resulta suficiente para mostrar que las punciones percutáneas de la arteria radial para la realización de procedimientos por cateterismo, en pacientes con disección previa de la arteria humeral, son factibles y permiten elevadas tasas de éxito con baja frecuencia de complicaciones.(AU)

The percutaneous punction of the radial artery for catheterization procedures has gained acceptance lately. This was a consequence of achieving results similar to the femoral approach, with the benefits of a lower rate of complications and increased comfort for the patients post procedure. Recently it has gained an additional impulse with the better prognosis obtained in acute coronary syndromes. In this trial we have evaluated if the feasibility, results and advantages related with the use of the radial artery percutaneous approach to perform catheterization procedures, continues when used in patients who have had a previous brachial artery cutdown. Out of a total of 1356 percutaneous radial accesses, 53 were in patients with previous brachial artery cutdown. Through this access 71 catheterization procedures were performed, achieving access success in 96.2% (51/53) of the punctions. Once the access success was obtained, 93.6% (44/47) of the diagnostic procedures and 100% (24/24) of the therapeutics procedures were successful. During hospitalization, in this group of patients, no major adverse cardiac events occurred and there was a 1.4% (1/71) rate of minor events. At seven days follow up, no new complications were recorded. Although this is a small group, we believe that it is enough to show that percutaneous punctions of the radial artery to perform catheterization procedures, in patients with previous brachial artery cutdown, are feasible, allowing high access and procedure success rates, with a low frequency of complications.(AU)

[Transradial percutaneous approach for cardiac catheterization in patients with previous brachial artery cutdown]. / Cateterismo cardíaco por acceso radial precutáneo en pacientes con disección humeral previa.

The percutaneous punction of the radial artery for catheterization procedures has gained acceptance lately. This was a consequence of achieving results similar to the femoral approach, with the benefits of a lower rate of complications and increased comfort for the patients post procedure. Recently it has gained an additional impulse with the better prognosis obtained in acute coronary syndromes. In this trial we have evaluated if the feasibility, results and advantages related with the use of the radial artery percutaneous approach to perform catheterization procedures, continues when used in patients who have had a previous brachial artery cutdown. Out of a total of 1356 percutaneous radial accesses, 53 were in patients with previous brachial artery cutdown. Through this access 71 catheterization procedures were performed, achieving access success in 96.2% (51/53) of the punctions. Once the access success was obtained, 93.6% (44/47) of the diagnostic procedures and 100% (24/24) of the therapeutics procedures were successful. During hospitalization, in this group of patients, no major adverse cardiac events occurred and there was a 1.4% (1/71) rate of minor events. At seven days follow up, no new complications were recorded. Although this is a small group, we believe that it is enough to show that percutaneous punctions of the radial artery to perform catheterization procedures, in patients with previous brachial artery cutdown, are feasible, allowing high access and procedure success rates, with a low frequency of complications.

Cateterismo cardíaco por acceso radial precutáneo en pacientes con disección humeral previa. / [Transradial percutaneous approach for cardiac catheterization in patients with previous brachial artery cutdown].

The percutaneous punction of the radial artery for catheterization procedures has gained acceptance lately. This was a consequence of achieving results similar to the femoral approach, with the benefits of a lower rate of complications and increased comfort for the patients post procedure. Recently it has gained an additional impulse with the better prognosis obtained in acute coronary syndromes. In this trial we have evaluated if the feasibility, results and advantages related with the use of the radial artery percutaneous approach to perform catheterization procedures, continues when used in patients who have had a previous brachial artery cutdown. Out of a total of 1356 percutaneous radial accesses, 53 were in patients with previous brachial artery cutdown. Through this access 71 catheterization procedures were performed, achieving access success in 96.2

(51/53) of the punctions. Once the access success was obtained, 93.6

(44/47) of the diagnostic procedures and 100

(24/24) of the therapeutics procedures were successful. During hospitalization, in this group of patients, no major adverse cardiac events occurred and there was a 1.4

(1/71) rate of minor events. At seven days follow up, no new complications were recorded. Although this is a small group, we believe that it is enough to show that percutaneous punctions of the radial artery to perform catheterization procedures, in patients with previous brachial artery cutdown, are feasible, allowing high access and procedure success rates, with a low frequency of complications.

The superficial ulnar artery: development and clinical significance

The principal arteries of the upper limb show a wide range of variation that is of considerable interest to orthopedic surgeons, plastic surgeons, radiologists and anatomists. We present here a case of superficial ulnar artery found during the routine dissection of right upper limb of a 50-year-old male cadaver. The superficial ulnar artery originated from the brachial artery, crossed the median nerve anteriorly and ran lateral to this nerve and the brachial artery. The superficial ulnar artery in the arm gave rise to a narrow muscular branch to the biceps brachii. At the elbow level the artery ran superficial to the bicipital aponeurosis where it was crossed by the median cubital vein. It then ran downward and medially superficial to the forearm flexor muscles, and then downward to enter the hand. At the palm, it formed the superficial and deep palmar arches together with the branches of the radial artery. The presence of a superficial ulnar artery is clinically important when raising forearm flaps in reconstructive surgery. The embryology and clinical significance of the variation are discussed.

As principais artérias do membro superior apresentam uma ampla variação, que é relativamente importante a cirurgiões ortopédicos e plásticos, radiologistas e anatomistas.Apresentamosumcaso de artéria ulnar superficial encontrada durante dissecção de rotina de membro superior direito de um cadáver masculino de 50 anos de idade.Aartéria ulnar superficial originava-se da artéria braquial, cruzava o nervo mediano anteriormente e percorria lateralmente esse nervo e a artéria braquial. A artéria ulnar superficial no braço deu origem a um ramo muscular estreito do músculo bíceps braquial. Ao nível do cotovelo, a artéria percorria superficialmente a aponeurose bicipital, onde era cruzada pela veia cubital mediana. Percorria, então, em sentido descendente e medialmente superficial aos músculos flexores do antebraço, e então descendia para entrar na mão. Na palma, essa artéria formava os arcos palmares superficial e profundo junto com os ramos da artéria radial.Apresença de uma artéria ulnar superficial é clinicamente importante ao levantar retalhos do antebraço em cirurgias reconstrutivas.Aembriologia e relevância clínica da variação são discutidas.

Angiografia coronária: técnica transbraquial revisitada / Coronary angiography: transbrachial technique revisited

Objetivo: Demosntrar a experiência na execução da técnica de punção braquial para a realização de coronariopatia. Método: Foram avaliados 106 pacientes ambulatóriais com suspeita de doença coronária submetidos a coronariografia pela técnica transbraquial. Foi pré-selecionado cateter MP2 introduzido através de bainha 5F, e o cateterismo esquerdo e angiográfico realizado da maneira usual. Ao término do exame foi retirada a bainha e a hemostasia realizada por compressão manual. Resultado: A maioria dos exames (76,4 por cento) foi completada com a utilização de um único cateter (MP2). A mediana do tempo de fluoroscopia foi 4,5 min. Em apenas 4 casos a técnica teve que ser substituída, todas ocorreram com um mesmo operador durante a curva de aprendizagem. Observamos a presença de hematoma de pequeno volume em 3 pacientes, logo após o procedimento, áreas discretas de esquimose em 4 e equimoses mais extensas em 6 doentes, não tendo ocorrido complicações graves. Conclusões: A técnica transbraquial mosntrou-se efetiva e segura , facilitando a realização de cateterismo ambulatorial com baixa frequência de complicações.

Objectives: To report the experience using the transbrachial approach for coronary angiography. Methods: 106 patients were studied with possible diagnosis of coronary artery disease using transbrachial catheterization. A preselected catheter (MP2) was introduced through a 5 F sheath and left heart catheterization and angiography performed in the usual manner. At the end of the procedure, the sheath was removed and hemostasis accomplished by manual compression. Results: Most procedures (76.4%) were performed with a single catheter (MP2). The median fluoroscopy time was 4.5 min. In only 4 cases, during the learning curve of one operator, a different technique had to be performed. Three patients suffered small hematomas, 4 patients presented with small and 6 with moderate ecchymosis; there were no severe complications. Conclusions: The transbrachial technique is effective and safe; it has facilitated outpatient catheterization with a low rate of complications.

Cross-chest radial nerve transfer in brachial plexus injuries. Experimental and anatomical basis.

Brachial plexus avulsion injuries are devastating injuries to the upper limb, and nerve transfer remains the only option in reconstruction. Despite the encouraging results concerning recovery of shoulder and elbow function, no option is available for treatment of the paralytic hand. In rats, we sectioned the radial nerve in the elbow region and transferred it across the chest to reinnervate the lesioned contralateral medial cord of the brachial plexus. Rats were then evaluated for motor and sensory recovery, electrophysiologically, behaviorally and morphologically. Forepaw functional recovery was estimated to be 90%. In cadavers, the radial nerve and profunda brachii artery were dissected. It was observed that the radial nerve vascularized by the profunda brachii artery was able to reach the contralateral brachial plexus distal to the shoulder region without nerve grafts. After sectioning the radial nerve, sensory loss is minimal and motor palsy can be easily restored by tendon transfers. The results of tendon transfer for radial nerve palsy are better than for any other nerve. Cross-chest radial nerve transfer might be of clinical interest in the reconstruction of hand function in entire injury to the brachial plexus.

Tratamiento de la isquemia grave luego de fístula arteriovenosa mediante ligadura arterial y by pass / Treatment of severe ischemia after arterio-venous fistula by artery ligation and bypass

Se realiza una revisión de la incidencia, patogenia y tratamiento de la isquemia severa del miembro superior luego de realizada una fístula arteriovenosa (FAV), en relación con dos casos tratados mediante ligadura arterial distal a la anastomosis y bypass. La incidencia global de esta complicación es baja, aunque significativamente mayor para las FAV en situación proximal que para las realizadas en el puño. Se consigna un alto porcentaje de amputaciones en las distintas series consultadas. En el tratamiento tiene importancia la conservación de la FAV en pacientes que van agotando las posibilidades de realizarlas. La revisión de los distintos procedimientos quirúrgicos utilizados para su tratamiento destaca los buenos resultados obtenidos con la ligadura arterial distal a la anastomosis y revascularización con un puente entre arteria proximal y distal

Tratamiento de la isquemia grave luego de fístula arteriovenosa mediante ligadura arterial y by pass / Treatment of severe ischemia after arterio-venous fistula by artery ligation and bypass

Se realiza una revisión de la incidencia, patogenia y tratamiento de la isquemia severa del miembro superior luego de realizada una fístula arteriovenosa (FAV), en relación con dos casos tratados mediante ligadura arterial distal a la anastomosis y bypass. La incidencia global de esta complicación es baja, aunque significativamente mayor para las FAV en situación proximal que para las realizadas en el puño. Se consigna un alto porcentaje de amputaciones en las distintas series consultadas. En el tratamiento tiene importancia la conservación de la FAV en pacientes que van agotando las posibilidades de realizarlas. La revisión de los distintos procedimientos quirúrgicos utilizados para su tratamiento destaca los buenos resultados obtenidos con la ligadura arterial distal a la anastomosis y revascularización con un puente entre arteria proximal y distal(AU)