Emergency ligation of the brachial artery for complications of vascular access

Abstract

Safe, if there is no alternative

Hand Ischemia Associated With Dialysis Vascular Access: An Individualized Access Flow‐based Approach to Therapy

“…The brachial artery has several well‐formed collaterals that are capable of providing perfusion to the forearm and hand, the major one of which is the deep brachial artery . In patients with an arteriovenous access, it is possible to ligate the brachial artery without causing ischemia of the distal extremity as long as severe arteriopathy is not present distally . After the application of a ligature to the brachial artery in the upper third of the arm, the circulation is maintained by branches from the humeral circumflex and subscapular arteries anastomosing with ascending branches from the deep brachial artery.…”

Emergency brachial artery ligation for ruptured infected pseudoaneurysm of haemodialysis access is a possible option

“…10 Various techniques have been described for aneurysm repair in literature. 5,[9][10][11][12][13] In our study, patients needed emergency treatment due to lifethreatening bleeding. In the presence of infection and significant blood loss, repair may lead to blowout and other catastrophes.…”

“…Although repair with biologic conduits has been described for peripheral artery bypass, 12,13 ligation of brachial artery is one of the methods to prevent blowout of the arterial repair due to persisting or resistant infection. 5 AVF at radiocephalic level can be safely ligated, as there is a good supply from ulnar artery to palmar arch but ligation of brachial artery at elbow always raises concern of critical limb ischaemia of hand.…”

“…Ligation of the brachial artery just above the elbow and before bifurcation provides rich collateral flow from the top. 5 This is the ideal site for ligation, as there is a rich collateral circulation which will compensate for the brachial artery ligation. If high ligation is done and collateral circulation is inadequate, then revascularization is necessary.…”

“…In the presence of infection, stents are contraindicated, and repair will be a futile attempt, and mostly an arterial repair results in a blowout. Tan and Tan 5 proposed that ligation of the brachial artery at the elbow area can be done safely due to large collaterals in that area. In this study, we have analysed our results of ligating the brachial artery as a treatment modality for ruptured pseudoaneurysm of arteriovenous access.…”