Surgical treatment of a rare brachial artery aneurysm postarteriovenous fistula closure after kidney transplant:A case report

BACKGROUND Brachial artery aneurysms are defined as dilations greater than 50%of the normal diameter,which are rare among all peripheral arterial aneurysms.While they are often present as pseudoaneurysms,true brachial artery aneurysms are also detected rarely.In this case report,the surgical repair method of true brachial artery aneurysms,which is a rare condition,is explained.CASE SUMMARY Herein,we present a 61-year-old male patient with complaints of swelling and pain in the right arm antecubital region that had been progressing over 6 mo.Upon the diagnosis of a true brachial artery aneurysm associated with arteriovenous fistula,the aneurysm was surgically repaired with an autologous saphenous vein graft.The patient was discharged without any neurovascular complications postoperatively.CONCLUSION True brachial artery aneurysms are rare and there are not any recommendations for their management in the current literature.Even though the treatment of true aneurysms in this artery is primarily based on a surgical treatment,endovascular repair also might be an option.

Discrepancy of blood pressure between the brachial artery and radial artery

BACKGROUND:In this study,we attempted to find the relations between blood pressure(BP)measured on the brachial artery(bBP) and BP assessed on the radial artery(rBP) in the right arm.METHODS:Three hundred and fifteen patients were enrolled in this study.Those who had peripheral vascular disease,wounds of arm skin or subcutaneous tissue infection were excluded.After a 15-minute equilibration and stabilization period after inducation of anesthesia,three bBP and rBP records were obtained sequentially using an oscillometric device with an adult cuff and infant cuff,respectively.Order for each BP was randomized.RESULTS:The bBP was significantly lower than the rBP(P<0.05).The difference between the two values varied from 13 to 18 mmHg in systolic BP(SBP),diastolic BP(DBP) and mean blood pressure(MAP) respectively.And the rBP was positively correlated with the bBP(r=0.872,0.754,0.765;P<0.001,<0.001,<0.001;SBP,DBP,MAP,respectively).CONCLUSION:The bBP value can be evaluated by the noninvasive measurements of rBP using an appropriate cuff in clinical practice.

RELATIONS OF ENDOTHELIAL FUNCTION AND BLOOD FLOW IN BRACHIAL ARTERY AND CORONARY ARTERY

Objective:To determine the relations between endothelium-dependent vasodilator function and blood flow in the brachial and coronary arteries in patients with suspected coronary artery disease.Methods:Twenty-eight patients with suspected coronary artery disease underwent brachial artery endothelial function test by using high-resolution B-mode ultrasound before coronary angiography(CAG)and coronary flow reserve(CFR)test by using intracoronary Doppler technique.The correlation of coronary artery dilatation induced by an increase in blood flow after intracoronary adenosine infusion and brachial artery flow-mediated dilatation(FMD) following reactive hyperemia was evaluated.The relation between the change of brachial artery blood flow and CFR was also studied.Results:There was a positive correlation between brachial FMD and percent change of coronary diameter after adenosine infusion(12.50%±9.35% vs 11.38%±7.55%,r=0.425,P=0.02).There was also a weak negative relation between brachial flow change following reactive hy-peremia and CFR(r=-0.397,P=0.04).Conclusion:There is a correlation between the coronary endo-thelial function and the CFR by ultrasonic determination of brachial flow changes following reactive hyperemia.

latrogenic brachial artery injury during anterolateral plat- ing of humeral shaft fracture

There are several well defined indications for surgical management of humeral shaft fractures.Operative procedures on the humerus are associated with their own complications.Iatrogenic brachial artery injury as a complication of humeral shaft plating has not been reported previously.We report a case of a 48 years old femalewho received operation at a district hospital and was referred to us when the surgeon could not palpate the pulse.CT angiogram showed that there was segmental non-opacification of the brachial artery.There was distal reformation and the thrombosis was decided to be managed conservatively.We believe that the arterial injury was a result ofimproper surgical technique and the segmental block might be due to improper use of plate holding forceps.This case report makes us aware of a rare complication of operative management of humeral shaft fractures and that basic principles of surgery must be always followed to prevent such injuries.

Assessment of the Endothelial Function with Changed Volume of Brachial Artery by Menstrual Cycle

The endothelial function has been proven to be an important factor in the pathogenesis of atheroscle-rosis, hypertension and heart failure. The flow-mediated vasodilation (FMD) of the peripheral artery is an endothelium-dependent function. Brachial-artery ultrasound scanning is the popular method for evaluat-ing FMD.

Brachial arteries sympathetic innervation: A contribution to anatomical knowledge

BACKGROUND The sympathetic nervous system makes medium and large peripheral arteries smaller to slow the blood flowing through them.AIM To observe brachial artery sympathetic innervation.METHODS We developed a neurophysiological autonomous test that measured the effects of peripheral sympathetic fibres on peripheral arteries.Our specific objective was to find the sympathetic innervation of the brachial artery.To accomplish this purpose,the brachial artery baseline diameter and flow rate were measured in the right arm of the patients.Afterwards,electrical stimulus was applied to the medial nerve for 5 s.Through electrical sympathetic activation,the vessel diameter and overall flow rate will decrease.After 7 d,a similar experiment was repeated using the ulnar nerve.RESULTS The differences in diameter and flow rate of the brachial artery in response to median and ulnar nerve activation were compared.In the total group,no significant difference in diameter was seen between medial and ulnar nerve stimulation(P=0.648).The difference in absolute slowdown of flow rate between median nerve stimulation and ulnar nerve stimulation was not statistically significant for the entire group(P=0.733).CONCLUSION As a target organ,the brachial artery receives an equal amount of sympathetic innervation from the median and the ulnar nerves.

Risk factors and ankle brachial indexes in cerebral infarction combined with peripheral arterial disease

BACKGROUND: Ankle brachial index (ABI) is widely involved in researches and clinical application of peripheral vascular injury of patients with diabetes mellitus (DM); however, the application in cerebral infarction (CI) is rare. OBJECTIVE: To investigate the possible risk factor of cerebral infarction plus peripheral arterial disease (PAD), compare metabolic characteristics of patients who having CI plus PAD or only having CI, and understand the significance of ABI on screening and diagnosing CI plus PAD of lower limb. DESIGN: Contrast observation based on CI patients. SETTING: Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region. PARTICIPANTS: A total of 124 CI patients were selected from Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region from July 2005 to April 2006, including 72 males and 52 females aged from 45 to 88 years. All patients met the diagnostic criteria of cerebrovascular disease established by National Academic Conference of Cerebrovascular Diseases in 1995 and determined as cerebral infarction with MRI or CT examination. All patients provided informed consent. There were 46 cases (37.2%) with CI plus PAD and 78 cases (62.8%) only with CI. METHODS: Blood pressure of bilateral ankles and upper extremities was measured at plain clinostatism with DINAMAP blood pressure monitor (GE Company). The ratio between average systolic pressure of lateral ankle and average systolic pressure of both upper extremities was regarded as ABI. The normal ABI was equal to or more than 0.9. If ABI < 0.9 occurred at one side, patients were diagnosed as PAD. On the second morning after hospitalization, blood was collected to measure fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG2h), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Among them, blood glucose, lipid and other biochemical markers were measured with enzyme chemistry assay and HbA1c was measured with HbA1c meter based on high liquid phase. Measurement data and enumeration data were compared with t test and Chi-square test, and multiple factors were dealt with Logistic regression analysis and multivariate linear regression analysis. MAIN OUTCOME MEASURES: Results of correlation between ABI and metabolic markers with multivariate linear regression analysis; risk factors of CI plus PAD with Logistic regression analysis; comparisons of metabolic markers between PAD and non-PAD patients. RESULTS: All 124 patients with acute CI were involved in the final analysis. ① Comparisons of metabolic markers: Levels of serum LDL-C and uric acid (UA) were higher of PAD patients than those of non-PAD patients (t =2.051 9, 3.339 1, P < 0.05); however, there were no significant differences among other metabolic markers (P > 0.05). ② Results of multivariate linear regression analysis: PBG2h, LDL-C and UA were obvious correlation with ABI of posterior tibial artery of lower limb and dorsal pedis artery (partial regression coefficient = -0.231 to -1.010, P < 0.05). ③ Risk factors of CI plus PAD with Logistic regression analysis: Age, smoking history, sum of CI focus (≥3) and LDL-C were independent risk factor of CI plus PAD (OR =1.524-5.422, P < 0.05-0.01). CONCLUSION: ① Levels of serum LDL-C and UA of patients with CI plus PAD are high. ② ABI of lower limbs is correlation with PBG2h, LDL-C and UA. In addition, measuring ABI is beneficial for early diagnosing PAD of lower limbs of patients who have poorly controlled blood glucose, abnormal lipid and poor renal function. ③ Age, LDL-C and sum of CI focus (≥3) are independent risk factors of CI plus PAD. It is of significance for screening non-PAD patients to evaluate risk degrees and prognosis and select therapeutic methods based on ABI measurement.

Can the change of vasomotor activity in irritable bowel syndrome patients be detected via color Doppler ultrasound?

BACKGROUND Irritable bowel syndrome(IBS)is one of the most frequently referred conditions to the gastrointestinal outpatient clinic.The pathophysiology of IBS has not been determined with certainty.Visceral hypersensitivity is indicated as one of the pathophysiologies.The sympathetic nervous system is primarily in charge of controlling the arteries,and its effect is vasospasm in the medium and large arteries,resulting in decreased blood flow.AIM To demonstrate,using Doppler evaluation of the brachial artery,that sympathetic activity impairs vasomotor performance due to autonomic neuropathy,which we believe is associated with IBS.METHODS There were 58 participants in the study.The control group consisted of 29 healthy patients,while the remaining 29 patients had been diagnosed with IBS.Patients who met the Rome IV criteria and had IBS were included in the study.People with known polyneuropathy or non-IBS chronic conditions that can progress were excluded from the trial,as were those with essential hypertension,diabetes mellitus,cardiovascular disease,or peripheral arterial disease,and patients diagnosed with anxiety or depression.Those with moderate to severe carpal tunnel syndrome or a median nerve lesion due to trauma were also excluded from the trial.A Doppler probe was used to measure the baseline diameter and flow rates of the brachial artery from 2 cm superior to the antecubital fossa.The Doppler probe remained stationary throughout the experiment,allowing for continuous measurements.Then,to activate the sympathetic fibers,an electrical stimulus for 5 s with an intensity of 10 mA and a frequency of 1 Hz was applied to the median nerve at the wrist level via the bipolar stimulus electrode.The artery diameter and flow rates were measured again immediately following the fifth stimulus.RESULTS In healthy persons with no history of chronic illness,there was a statistically significant decrease in flow rate after stimulation(P<0.001).In addition,stimulation resulted in a statistically significant reduction in the diameter of the brachial artery(P<0.001).Patients diagnosed with IBS had statistically significant vasodilation and an increase in flow rate.CONCLUSION Sympathetic stimulation causes a reduction in vascular diameter and blood flow,whereas it has the reverse effect on IBS patients.In investigating the involvement of autonomic neuropathy in the development of IBS,significant changes in brachial artery Doppler parameters were observed before and after stimulation of the median nerve with low-current sensory stimulation.This method is thought to be more user-friendly and comfortable than other methods described in the literature.

mpaired flow-mediated vasodilatation in Asian Indians with erectile dysfunction

Endothelial dysfunction is the postulated link between coronary artery disease （CAD） and erectile dysfunction （ED）. Brachial artery flow-mediated vasodilatation （FMD） is a non-invasive surrogate marker for endothelial function assessment. Despite Asian Indians representing a considerable global CAD burden, data on FMD and ED in these patients are lacking. Of the 225 patients undergoing coronary angiography, 72% had ED （assessed using the International Index of Erectile Function （IIEF-5） questionnaire）; ED was moderate to severe in 61% of the patients. ED patients had a higher incidence of severe and diffuse angiographic CAD, a greater number of coronary vessels involved and a lower mean brachial artery FMD （6.40%±4.60% vs. 9.10%±4.87%, P〈0.001） compared to non-ED patients. A progressive reduction in FMD was noted with increasing severity of ED. Impaired FMD （ ≤ 5.5%） was twice as common in ED patients （52% vs. 24% without ED）. Patients with impaired FMD had higher ED prevalence （85% vs. 62%） and lower mean I IEF-5 scores compared to those with normal FMD. Impaired FMD was a significant ED predictor independent of other risk factors （odds ratio, 2.33; 95% confidence interval： 0.59-9.23; P=0.03）. An inverse correlation between FMD and ED severity was observed （r=-0.22; P=0.004）. ED is common among Asian Indians with angiographically documented CAD. Patients with ED have impaired FMD independent of other risk factors, suggesting that endothelial dysfunction is the underlying pathophysiology. Urologists and cardiologists need to be aware of the association between ED, CAD and endothelial dysfunction.