This is Brachial artery angiogram showing - total occlusion of the radial artery close to its origin. The ulnar is showing short segment of stenosis. The median interosseous artery is reformed and coursing down wards in the middle of forearm.
During surgery, the brachial artery and its bifurcation were found to be be engulfed by inflammatory tissues with excessive adhesions and edema. The tissues are fragile and the veins are dilated and thickened. The arterial wall is also fragile, thickened along with multiple dilated venules over its wall. The thinned walled collateral (neovascularization) vessels in the arterial walll are easily bruising. It is suggestive of a chronic process affecting (in elbow region) affecting brachial, radial and ulnar arteries and bifurcation. The brachial and ulnar artery were felt after the dissection and isolation of areteries with release of tight adhesive inflammatory tissues around them.
There was strong clinical suspicion of Behcet's syndrome based on the findings in this patient. He was given steroid in the peri-operative period and his clinical condition significantly improved. Through multiple incisions in the forearm and plam fasciotomies were done to release intra compartmental pressure.
15th Nov 2008