Response to the Article Entitled “Endovascular Repair of a Traumatic Axillary Artery Pseudoaneurysm,” by R. M. Kumar et al.

Excerpt

In their recent article entitled “Endovascular Repair of a Traumatic Axillary Artery Pseudoaneurysm” [1], R. M. Kumar et al. report the successful closure of a leaking axillary pseudoaneurysm with a stent-graft in a 72-year-old lady with fracture dislocation of the upper end of the humerus. It was evident that the axillary aneurysm was formed secondary to arterial injury caused by sharp bone fragments of the body of the humerus or by traction or contusion of humeral head [2]. Instead of the standard treatment of open reduction and fixation of the humerus fracture along with surgical repair of the axillary pseudoaneurysm [3, 4], the authors preferred the temporary measure of placing the stent-graft and deferred the definitive treatment for a later, more elective situation. The comorbid illness in the elderly lady that made the authors defer the decision for definitive surgery is not clear. It is also not clear whether compressive brachial plexus neuropathy, which is a common consequence [5, 6] in such cases, was present or absent. A coordinated approach of vascular and orthopedic surgeons to manage the fracture of the humerus and concomitant neurovascular injuries surgically, along with evacuation of the large axillary hematoma, would have been ideal [4] in comparison to the partial treatment of the axillary pseudoaneurysm by an attractive endovascular approach. Figure 5 of their article [1], reproduced here with better imaging quality (Fig. 1), also shows an underexpanded stent, possibly because of external compression by the large hematoma, as well as a thrombus just distal to the stent. Follow-up details about stent-graft patency, in view of the underlying sharp and protruding fractured bony segments, underexpanded stent, and thrombus presence distal to the stent, about stent-graft restenosis, and about possible corrective open reduction and fixation of the humerus fracture are also not provided in the case description; clarification by the authors is necessary.

…