Delayed presentation of complete arterial transection treated with interposition graft: A case report

INTRODUCTION: Traumatic arterial injuries have a high degree of morbidity if left untreated. Frequently, arterial injuries are found soon after injury due to either subjective complaints or objective findings. Opportunity for delayed repair of vascular injury is a rare event as irreversible ischemia occurs at such early time points. CASE REPORT: We report a case of delayed presentation of complete arterial transection of the brachial artery due to penetrating trauma, but without classical hard signs of vascular injury. Trajectory, symptoms, and pulse exam prompted further evaluation. Successful reverse saphenous vein interposition grafting of the transected artery returned normal blood flow to the affected extremity with preserved function. CONCLUSION: This case of delayed presentation of arterial transection is significant as delayed identification of arterial injury is rare. Furthermore, it demonstrates the need for clinicians to have a high index of suspicion in patients with traumatic limb injuries who present in a subacute or delayed fashion with increasing pain and worsening of initial physical exam findings.