Rare case of brachial artery laceration caused by blunt trauma in volleyball player reported

Chiba-Ken, Japan: Brachial artery injuries due to penetrating injuries or high-energy blunt trauma are common, but those due to blunt injuries are relatively rare. Supracondylar fractures or dislocation of the humerus have been reported as causes of arterial injury related to low energy trauma. However, low-energy blunt brachial artery blunt injuries among civilians, such as amateur volleyball players are extremely rare.

According to the history a 33-year-old woman was referred to the hospital for evaluation of swelling and pain in the left upper arm. She did not have risk factors for arterial sclerotic disease other than smoking history for 20 years. She denied any accidental collision of her arm or unusual pain in her elbow joint, other than her usual game of volleyball played two days earlier. Before her visit to the hospital, she visited a rural clinic with these complaints. At that visit, the diagnosis was mild skin and subcutaneous edema due to impact injury. However, as the symptoms worsened rapidly, she was referred to this hospital a day later. Upon examination in emergency clinic, the pulsation of the left radial artery was weak and the left forearm was relatively cold. However, paresis and paralysis were not observed. A duplex ultrasound examination revealed a hematoma around the left brachial artery and a pseudoaneurysm in the distal brachial artery. Enhanced computed tomography (CT) confirmed these findings. Concomitant injury, such as a fracture or dislocation of the joint was not seen in the CT.

Emergency surgery was performed. A hockey stick-shaped incision was placed on the left distal brachium and cubital fossa. The brachial artery was located in the hematoma. A two-cm long laceration was observed on the artery. The condition of arterial wall around the laceration was poor, and the lesion was resected (4 cm in length). The defect was long, and it was interposed by a reversed saphenous vein graft. The wound was closed after the placement of a negative pressure drain. After confirmation of hemostasis, continuous heparin administration was started 6 h after the surgery, which was later replaced with apixaban (dose:10 mg/day) on the sixth day post-surgery. Apixaban was continued for a month. The patient was discharged a week after the surgery without any symptoms. During the two-month follow-up period, the patient did not show any other symptoms and continued to improve.

The authors concluded that they encountered a case of blunt trauma of an amateur volleyball player who needed surgery. There should be an increased awareness about blunt vascular injury even though high-velocity traumatic mechanisms or penetrating episodes are absent.

Key Words: Blunt traumatic injury, Brachial artery, Volleyball, Reversed saphenous vein graft

Further reading:

Rare brachial artery injury caused by blunt trauma; a case of the brachial artery laceration in an amateur volleyball player.

Yohei Kawatani, Takaki Hori

Trauma Case Reports 37 (2022) 100570

https://doi.org/10.1016/j.tcr.2021.100570