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Vascular injuries resulting from arthroscopic surgeries are rare with a reported incidence of 0.005% of elective orthopedic procedures. We report a case of a 49-year-old male who developed a deep brachial artery pseudoaneurysm following an arthroscopic shoulder debridement and lysis of adhesions. He was successfully embolized with resolution of the pseudoaneurysm within 6 weeks of treatment. A review of the literature demonstrates that pseudoaneurysm formation after arthroscopic procedures is rare and pseudoaneurysms of the deep brachial artery have yet to be reported.

Relationships between femoral artery pulsatility index (PI) (a number calculated from Doppler-derived arterial blood velocity waveforms) and three directly measured physiologic parameters (proximal artery stenosis, blood pressure index (BPI), and blood flow) were studied in a canine model. All combinations of stenoses were constructed, including 0%, 25%, 50%, 75%, and 90% reduction in a cross-sectional area in the infrarenal aorta and/or left common iliac artery of 14 animals. PIs, BPIs, and mean blood flows were measured for each stenosis pattern at both the right (control) and left femoral arteries. Three groups were studied--group I, the left femoral artery remained open; group II, the left femoral artery was ligated; and group III, a left femoral arteriovenous fistula was constructed. Correlations between reductions in femoral artery PI and increasing arterial stenosis as well as decreasing BPI and blood flow were obtained. However, positive correlations were weak and only recognized when high-grade stenoses were present. Moreover, these correlations were further influenced by the multiplicity of stenoses present as well as flow velocity into the distal arterial bed. These data suggest that PI lacks the sensitivity to be a clinically useful diagnostic test.

Anastomotic intimal hyperplasia (AIH) is a common cause of graft failure after femoropopliteal polytetrafluoroethylene (PTFE) bypass. Compliance mismatch between the PTFE graft and the native artery may be a significant factor causing AIH. This study examines whether reduction of compliance mismatch by interposition at the distal anastomosis of a segment of superficial femoral artery after eversion endarterectomy could reduce or eliminate AIH and improve graft patency. Between July 1989 and June 1996, PTFE grafts with a distal arterial segment (AS) were used to revascularize 51 limbs in 45 patients (12 men and 33 women). Twenty-five grafts were above-knee (AK) and 26 below-knee (BK). Disabling claudication was the indication in 32 limbs (AK 20, BK 12) and limb-threatening ischemia in 19 (AK 5, BK 14). Physical examination, measurement of ankle-brachial index, and duplex scanning were used to follow up patients at regular intervals. For those patients who had recurrent symptoms and/or reduction of ankle/brachial index (ABI), arteriography was performed. Follow-up ranged from 1-54 months (mean 20 months) for AK grafts and 1-76 months (mean 19 months) for BK grafts. The overall primary patency rate at 4.5 years was 57.2%. There appears to be no significant difference between AK and BK primary patency survival distributions (64.8% vs 48.5%). The primary patency failure distributions for the two ischemic conditions are statistically significant (69.8% vs 31.9%). The limb salvage rate at 4.5 years was 80%. Of the 51 grafts, the causes of the 19 failures included progression of disease in eight, thromboembolus in three, stenosis of the AS in three, poor runoff in one, AIH at the proximal anastomosis in one, and unknown in three. This pilot study suggests that the femoropopliteal PTFE bypass with distal AS interposition provides improved graft patency and limb salvage rates when compared with those published in the literature for PTFE bypass without the AS. Further evaluation is warranted.

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An unusual case of traumatic asphyxia with cerebral and spinal cord symptoms is presented. A survey of the literature indicates that a primary cord lesion is very rare as a consequence of such a trauma. The possible pathogenetic mechanisms of these neurological manifestations are discussed.