Name:
12 Brachial Artery
Description:
12 Brachial Artery
Thumbnail URL:
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Duration:
T00H04M57S
Embed URL:
https://stream.cadmore.media/player/0637f59f-b997-47fe-b0fc-a664d5b3e335
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/0637f59f-b997-47fe-b0fc-a664d5b3e335/1220Brachial20Artery.mov?sv=2019-02-02&sr=c&sig=VUGW%2BLoeCbLVQEh6gReexLz1mjxkFKgDZjjP7%2FXR8U4%3D&st=2024-12-21T16%3A39%3A39Z&se=2024-12-21T18%3A44%3A39Z&sp=r
Upload Date:
2022-03-03T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
In this video, we will discuss the proper technique in order to expose the brachial artery.
Segment:1 Objectives.
First, we will begin by reviewing the anatomy, followed by the instruments required and proper positioning, the exposure and technique, and, finally, tips and pitfalls for this procedure.
Segment:2 Anatomy.
The brachial artery lies in the groove between the biceps and triceps muscles. The proximal brachial artery lies medial to the humerus and gradually travels lateral to lie anterior to the humerus distally.
Proximally, it has one major branch the profunda brachial artery. At the antecubital fossa, the brachial artery runs deep to the bicep STAPLE NEUROSIS and bifurcates into the radial and ulnar arteries. The brachial artery is surrounded by two brachial veins along its course, which are joined by the basilic vein proximally to become the auxiliary vein. The median nerve lies in front of the brachial artery in the upper arm and courses along the artery, eventually crossing over it and coursing deep to lay behind the artery in the lower arm.
The ulnar nerve lies behind the brachial artery in the upper arm, and at the mid arm it courses deep to enter the intermuscular septum away from the artery. These relationships are particularly important to remember in order to avoid inadvertent nerve injury during this exposure.
Segment:3 Instrumentation and Positioning.
The patient should be positioned supine, with the arm abducted 90 degrees, and externally rotated with the palm up. The prep should be circumferential from the hand to the shoulder, and the neck and chest should also be included, as well as the groin should a vascular conduit be required.
A standard vascular tray, tourniquet, Fogarty catheters, heparin, and a selection of shunts and conduits should also be available. The skin incision is made between the biceps and triceps muscle bellies. This may be extended proximally to the deltopectoral groove for axillary artery exposure. The incision can also be extended distally, curving toward the radius, in the antecubital fossa, to expose the brachial bifurcation. The first vascular structure to be encountered in this exposure is the basilic vein.
The basilic vein is then carefully dissected and mobilized in order to expose the underlying structures. Superior to the basilic vein, the brachial sheath is encountered and then sized. And then in the proximal arm, the median nerve is the first structure to be encountered. The median nerve is dissected carefully along its length. Recall that in the proximal arm the median nerve lies anteriorly over the brachial artery.
This relationship is demonstrated here. The brachial artery is dissected proximally in the upper arm. The profunda brachial artery is a large medial branch in the proximal third of the arm and in close proximity of the radial nerve. This branch should be preserved if uninjured, as it provides collateral circulation to the forearm.
Exposure of the distal brachial artery requires extension of the incision, curving radially across the antecubital fossa. The exposure is carried along the border of the biceps muscle distally to the biceps tendon. In order to gain exposure of the brachial artery bifurcation to the radial and ulnar arteries in the distal arm, the biceps tendon must be divided.
Once division of the tendon is completed, the bifurcation and proximal radial and ulnar arteries are easily accessible.
Segment:4 Tips and Pitfalls.
Points to remember during this exposure are that the median and ulnar nerves are in close proximity to the brachial artery. Intimate knowledge of the anatomy will help avoid inadvertent injury. The profunda brachial artery should also be preserved, if not injured, as it is an important source of collateral circulation to the rest of the arm.
In damage control situations, always consider a shunt over a definitive repair. And with brachial artery injury, I want you to always consider compartment syndrome and the need for a forearm fasciotomy. Thank you.
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