Traumatic proximal brachial artery injury selectively managed non-operatively: A case report and review of the literature

A right hand dominant 18-year-old female with a body mass index greater than forty presented to the trauma bay after sustaining two gunshot wounds to her right upper extremity. On physical exam, she had doppler signals and she reported neuropathy in the right median nerve distribution. She had no active signs of bleeding and she was subsequently taken to computed tomography which revealed an abrupt proximal brachial artery opacification with distal reconstitution in addition to having air tracking into the axillary and subclavian arteries. She underwent further resuscitation with normalization of perfusion as her radial and ulnar arteries became palpable. Traditionally, proximal brachial artery injuries are managed by an open surgical approach, which has a morbidity associated with the surgical dissection. Additionally in this case, there was concern for a blast injury near the potential graft inflow site. This case report highlights a patient who sustained a proximal brachial artery occlusion that was managed medically with antithrombotic agents and serial exams.