Insertion technique for the Impella 5.0 heart pump in the COVID-19 era

We describe the insertion of the Impella 5.0, a peripherally placed mechanical cardiovascular microaxial pump, in a patient with ischemic left ventricular dysfunction. The Impella is a 7 Fr device capable of achieving a flow of 4.0–5.0 L/min; its use necessitates an open arterial cut-down. A subclavicular incision is used to access the right or left axillary artery. A 10-mm tube graft is anastomosed to the artery through which the Impella 5.0 is inserted. The device traverses the tube graft and is advanced via the aorta, across the aortic valve, to its final position (inflow toward the ventricular apex and outflow above the aorta). The device may remain in situ for 10 days until recovery or until further supports are instituted. Our goal is to demonstrate the insertion of the Impella 5.0 device in a patient with cardiogenic shock whose situation was further complicated by coronavirus disease 2019.

Ruptured axillary artery pseudoaneurysm following an anterior glenohumeral dislocation: A case report

Vascular injuries following anterior shoulder dislocations are rare, with an estimated incidence of 1-2%. The formation of an axillary artery pseudoaneurysm secondary to vascular trauma is a possible late complication and frequently underdiagnosed since it may remain asymptomatic for many years. A rupture of a pseudoaneurysm may occur either from the dislocation itself or after forceful reduction attempts. A ruptured pseudoaneurysm of the axillary artery is a medical emergency and may result in significative upper-limb morbidity or even patient mortality. Nowadays, endovascular techniques have progressively gained ground for the treatment of such lesion, especially in an emergency context. In the present article, the authors present the case of a 77-years-old male patient with a rupture of a pseudoaneurysm of the left axillary artery after repeated forceful reductions of an anterior glenohumeral dislocation and its treatment with percutaneous endovascular stenting.

Rare Branching Pattern of the Subscapular Artery

Variations of the axillary artery and its branches are quite common. Some variations are clinically significant and having knowledge of them can be useful for the prevention of diagnostic errors during surgical interventions in the axillary fossa. Classically, the third part of the axillary artery presents three branches—the subscapular, the anterior, and the posterior circumflex humeral arteries. The subscapular artery is divided into the circumflex scapular and the thoracodorsal arteries. Our work presents a previously undescribed branching pattern of the right subscapular artery. It branched into the thoracodorsal, the circumflex scapular, the profunda brachii, and the anterior and posterior circumflex humeral arteries. The profunda brachii artery was 0.4 cm in diameter and ran inferiorly to the humeromuscular canal. No branches of the profunda brachii artery were found in the superior part of the arm before entering the humeromuscular canal. No variations in the other parts of the right axillary artery and of the left axillary artery were discovered. The described branching pattern of the subscapular artery can be important and essential for surgeons and radiologists.