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Abstract: The patient presented to the emergency room with the chief complaint of “right upper extremity glass cut for 5 hours”. A CTA of the upper extremity artery was immediately performed in the emergency room, and a brachial artery hemorrhage was considered based on the results, with the exception of a brachial vein hemorrhage, which was a vascular injury. After communication between the patient and the doctor, the patient underwent surgery in the emergency room. After surgery, the patient was given anti-infection and pain relief drugs.
Basic information】Male, 61 years old
Type of disease】Brachial artery bleeding (brachial vein bleeding is not excluded)
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】July 2021
Treatment plan】Surgical treatment (right upper limb exploration + brachial artery repair anastomosis + brachial vein ligation) + medication (Ceftriaxone sodium for injection, diazoxide injection)
Treatment period】7 days of hospitalization
Treatment effect】Arterial pulsation was restored after surgery, skin temperature and color were normal, CTA showed revascularization and good recovery
I. Initial consultation
In July 2021, a 61-year-old male patient presented to the emergency room with “a glass cut on the right upper extremity 5 hours after the injury”. The patient reported that he had been accidentally cut by glass after a fall from a height 5 hours earlier and had active bleeding in the right upper extremity, accompanied by coldness and numbness. The extremity was pale and mildly impaired in movement. He was treated with compression bandages and was transferred to another hospital several times before coming to our hospital for emergency treatment.
Emergency CTA showed that the lumen of the proximal segment of the right brachial artery was blurred and the distal lumen was not filled with contrast. A local soft tissue defect from the right lower middle humerus to the elbow joint was seen, with a mass-like soft tissue density shadow and a small bubble-like gas density shadow. On examination: the skin of the right upper limb was pale, the skin temperature was cool, the end capillary filling was poor, the right upper limb was wrapped with an elastic bandage with compression, the right brachial artery and radial artery were not pulsed, and the sensory-motor function of the right upper limb was mildly impaired. After admitting the patient to the hospital, the vascular condition was immediately evaluated and brachial artery bleeding was considered, with no exception for brachial vein bleeding. The patient’s vital signs were still stable, and the blood pressure was 120/80 mmHg.
II. Treatment history
After explaining to the patient and his family, the patient expressed willingness to follow the medical prescription for active treatment. The patient underwent exploration of the right upper extremity under emergency general anesthesia, postoperative exploration of the brachial artery, local debridement, brachial artery repair anastomosis, and brachial vein ligation. After the operation, the patient was given regular disinfection of the incision and dressing change, and the patient recovered arterial pulsation and sensory-motor function of the upper limb. After 1 week, the patient’s incision healed well, and the repeat CTA indicated that the size of the arterial lumen of the upper limb was normal and blood flow was restored.
III. Treatment effect
The patient’s surgical treatment effect was remarkable. After surgery, the brachial artery and radial artery pulsation recovered, the skin temperature of the right upper limb became warm, the skin color was red, and the sensorimotor function gradually recovered. One week after the surgery, the incision healed well, there was no obvious redness and exudation, and the symptoms of numbness, coldness, and pain in the right upper limb completely disappeared; the results of CTA of the right upper limb showed that the walls of the right brachial artery, radial artery, and ulnar artery were smooth, the lumen was smooth, and there were no obvious signs of stenosis or occlusion. The patient recovered well and was discharged from the hospital.
IV. Notes
We are glad that the patient recovered after the aggressive treatment in the hospital. However, postoperative care is equally important. In terms of diet, avoid spicy and stimulating food, greasy and smoky food, alcohol, fresh fruits and vegetables, and high-quality protein, such as eggs and milk, etc. In life, you can enhance the functional exercise of the hand, appropriate hand clenching, grasping and other exercises, such as finger to finger exercises, palm to palm exercises, etc. In addition, note that the injured limb should not be burdened with heavy objects for at least one month, and after one month, gradually increase the amount of activity according to the recovery situation, if necessary, regular rehabilitation in the rehabilitation department.
V. Personal insight
The patient was bleeding from the brachial artery, but the brachial vein was not excluded, which is a kind of vascular injury and a critical emergency in vascular surgery, and the consequences are unimaginable if not treated in time. Compression is most often used to stop bleeding in outdoor emergency, however, limb ischemia should not be too long, otherwise it will cause limb ischemic necrosis, and the most intuitive manifestation of ischemic necrosis is a decrease in limb end skin temperature, as in the patient of this case. Therefore, once a vascular injury occurs, after simple first aid measures, it is important to send to a vascular surgery center with life-saving capabilities for consultation and treatment as soon as possible. Once delayed, the lighter cases can lead to ischemic necrosis of the limb and eventual amputation, while the heavier cases can lead to hemorrhagic shock of the patient and eventually endanger life.