Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XX: Wounds and Injuries of Peripheral Nerves

Missile Wounds Leading to Aneurysm or Arteriovenous Fistula Complicating Nerve Injury

United States Department of Defense

An expanding mass in the shoulder and arm, the presence of a thrill and/or a bruit, and progressive loss of function with severe pain should alert the clinician to this possibility. The pain is almost like true causalgia with burning paresthesia and electric shocks, but usually presents without automatic manifestations. The patient, unlike the individual with true causalgia, usually permits manipulation of the distal extremity. To be accurate, traumatic aneurysms are usually pseudoaneurysms arising from dissection of blood into and around the vessel wall. Thus, angiography may not demonstrate extravasation of contrast or filling of the aneurysm. When this diagnosis is suspected, immediate exploration is indicated. At exploration, an aneurysmal mass or, in a few cases, a fistula will be found compressing and stretching neural elements. This situation is especially common when axillary or posterior popliteal vessels are involved.

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Operational Medicine 2001

Health Care in Military Settings

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