Case Report Axillary Artery Dissection After Scapular Fracture Ivan Cvjetko, 1 Mario Staresinic, 1 Dubravko Hlevnjak, 1 Bore Bakota, 2 and Ivana Dovzak, 3 Zagreb and Karlovac, Croatia Introduction: Q3 Blunt shoulder trauma rarely causes damage to either arteries or nerves. Neuro- vascular structures are covered by muscles and protected by the surrounding bones deep in the axilla. Case Report: We report a case of a 34-year-old male motorbike driver referred to us 5 hours after injury. Standard X-ray of the left shoulder revealed multipart fracture of the left scapula, and angiography showed that the first segment of the left axillary artery was dissected proximal to the minor pectoral muscle. Discussion: Urgent diagnosis using imaging techniques and restoration of blood flow using open or endovascular repair are crucial for optimal outcome. Damage to the nerves predicts the final functional outcome regardless of prompt revascularization. Blunt shoulder trauma rarely causes Q4 damage to either arteries or nerves. Neurovascular structures are covered by muscles and protected by the surrounding bones deep in the axilla. We report a case of a 34-year-old male motorbike driver referred to us 5 hours after injury. Standard X-ray of the left shoulder revealed multipart frac- ture of the left scapula, and angiography showed that the first segment of the left axillary artery was dissected proximal to the minor pectoral muscle. CASE REPORT We report a case of a 34-year-old male motorbike driver referred to us from another hospital 5 hours after the initial injury, which happened in a traffic accident. The patient had contusions of the head, left shoulder, left wrist, right knee, and both lower limbs. During clinical examination, the patient was fully awake, and on palpation, his abdomen was painless. His blood pressure was 130/90 mm Hg, heart rate was 115 beats/min, respiration rate was 18 breaths/min, and oxygen saturation was 98% (measured on the noninjured arm by using a pulse oximeter). The patient reported severe pain in the left shoulder and a limited range of motion. Deformity of the shoulder and hematoma spreading toward the left side of the neck and upper arm was visible. There were no palpable axillary, brachial, or radial artery pulses in the left arm. Pulses were present in the right arm. The muscles of the left arm innervated by the radial nerve were paretic, with hypoesthesia of the dorsal forearm. Capillary refilling in the fingers was present. Standard X-ray of the left shoulder, left wrist, right knee, lungs, spine, and both lower limbs revealed multi- part fracture of the left scapula, although the glenoid surface was intact. Computed tomography of the head and spine was performed and no additional injuries were found. Ultrasound of the abdominal cavity showed no significant pathology. Contrast angiography of the ascending aorta and selec- tive angiography of the left subclavian artery were per- formed. The left axillary artery was dissected in its first segment, proximal to the minor pectoral muscle (Fig. 1). 1 Department of Vascular Surgery, University Hospital Merkur, Zagreb, Croatia. 2 General Hospital Karlovac, Karlovac, Croatia Q1 . 3 University Hospital of Traumatology, Zagreb, Croatia. Correspondence to: Ivan Cvjetko, , Q2 Department of Vascular Surgery, University Hospital Merkur, Zajceva 19, 10 000 Zagreb, Croatia, E-mail: ivancvjetko@yahoo.com Ann Vasc Surg 2011; -: 1-3 DOI: 10.1016/j.avsg.2011.02.014 Ó Annals of Vascular Surgery Inc. Published online: --,- 1 AVSG944_proof - 21 March 2011 - 1/3 - ce 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110