Surgical complications of transaxillary arteriography: A case-control study

Abstract

Aggressive treatment of post-TRAX hypertension, limitation of TRAX duration, delay of postprocedure anticoagulation, and use of alternative sites for arterial puncture in female patients or patients undergoing catheter-based intervention may reduce the incidence of TRAX-related complications. In patients who have neurologic deficits prompt surgical exploration of the puncture site with decompression of the involved nerve(s) may reduce the incidence of prolonged deficits.

Hématome axillaire sur introducteur causant des complications neurologiques après accès artériel

“…4,5 The incidence from all published data ranges from 0.2 to 2.8%. 3,6,7 Patients range in age from 17 to 78 years (mean age: 56 years). Symptoms of persistent pain, motor, or sensory losses were reported immediately at the completion of angiographic studies in 38% of patients.…”

“…Associated risk factors include female sex, systolic blood pressure !150 mm Hg at the conclusion of the study, systemic heparin anticoagulation, intraarterial thrombolysis or percutaneous angioplasty, and duration of the procedure lasting !90 minutes. 7 A delayed onset of symptoms, of hours to days, may occur because of slow leakage of blood into the axillary sheath requiring time to form a compressive mass. Distal pulses are often preserved because the increased intra-compartmental pressure can compress nerve microcirculation without affecting arterial blood flow.…”

“…9 Other studies argue that any persistent or progressive neurologic deficit, sensory or motor, should alert one to emergently explore the axillary sheath. 7,10 The optimal time for surgical intervention is still unresolved. Most agree that decompression within a few hours of symptoms is more likely to produce complete neurologic recovery, whereas delay in surgery may result in permanent nerve damage.…”

“…Most agree that decompression within a few hours of symptoms is more likely to produce complete neurologic recovery, whereas delay in surgery may result in permanent nerve damage. 3,[9][10][11][12][13][14] Chitwood et al 7 showed that patients undergoing urgent surgeries within 4 hours from the onset of neurologic symptoms were 8.3 times more likely than patients treated with observation or delayed surgery to have complete neurologic recovery. Shoup et al 15 advised that all patients who present late should still strongly be considered for surgery because an inverse relationship exists between the duration of neurologic deficits and the likelihood of return of function.…”

Brachial Plexus Injury as a Complication after Nerve Block or Vessel Puncture

“…However, these procedures are not always safe and may cause various complications including brachial plexus injury (BPI) [6,7,8,9]. Additionally, the axillary arteriography, which has been used if the femoral route is not available, may also cause BPI [10]. …”