Evaluation and Management of Axillary Artery Injury: The Orthopaedic and Vascular Surgeon’s Perspective

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Axillary artery injury is a rare event, but it can lead to severe consequences such as mortality, amputation, or catastrophic limb disability1,2. Although uncommon in upper-extremity trauma, axillary artery injury has been described in association with shoulder dislocation3,4, proximal humeral fractures5-7, and penetrating trauma2,8,9. The largest review of axillary artery injury in proximal humeral fractures found an incidence of 331 (0.09%) of 388,676 proximal humeral fractures in the United States from 2002 to 20117. This analysis of the National (Nationwide) Inpatient Sample10 identified male sex, atherosclerosis, open fractures, associated brachial plexus injury, associated shoulder dislocation, associated scapular fractures, and associated rib fractures as risk factors for axillary artery injury in the setting of proximal humeral fracture7. The largest review of axillary artery injury in shoulder dislocation found an incidence of 9 axillary artery injuries (0.97%) in 931 shoulder dislocations presenting over a 5-year period to a Level-I trauma center11.
Axillary artery injury during shoulder surgical procedures has not been well described, to our knowledge. There were a case report describing an avulsive injury to the axillary artery during reverse total shoulder arthroplasty12, 2 cases of axillary artery thrombosis after humeral resurfacing arthroplasty13, a case of axillary artery injury during an open subpectoral biceps tenodesis14, a case report of axillary artery injury during proximal humeral fracture fixation in which the axillary artery was within a fracture callus15, a case series of axillary artery injury in 4 patients undergoing an open shoulder surgical procedure (2 for elective arthroplasty and 2 for open reduction and internal fixation to treat proximal humeral fracture)16, and a case report of a pediatric axillary artery injury after closed reduction and percutaneous pinning of a humeral neck fracture17. However, to our knowledge, there have been no studies that describe the true prevalence or risk factors for axillary artery injury during open or arthroscopic shoulder surgical procedures.
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