“Silent” false aneurysm: shrapnel injury of the axillary artery without signs of acute ischemia. The role of ultrasound diagnostics and surgical strategy

Combat-related trauma to peripheral arteries, including the formation of false aneurysms, remains one of the most challenging issues in military surgery. High-energy shrapnel wounds often result in injury to major vessels, requiring staged surgical management. The aim of the study. To present a clinical case of successful treatment of a thrombosed false aneurysm of the axillary artery following a shrapnel wound. Materials and methods. This report describes a case of a right shoulder injury in a 36-year-old serviceman. Two days after the injury, upon admission to a Level 2 military field hospital, a through-and-through shrapnel wound was diagnosed, complicated by axillary artery rupture with the formation of a thrombosed false aneurysm and compensated collateral circulation. Results. The multidisciplinary team decided to perform reconstructive surgery. Under endotracheal anesthesia, axillary artery reconstruction was performed using a reversed autologous great saphenous vein graft from the thigh. Intraoperatively, a thrombosed false aneurysm was noted. The postoperative course was uneventful, and arterial flow was restored. The patient was discharged 30 days later with restored limb function. Conclusion. This case demonstrates the efficacy and safety of delayed reconstructive interventions on major arteries, provided that circulation is compensated via collaterals and there are no infectious complications.

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