[Jun 17, 2024]
"This study validates the safety of overhead upper extremity positioning for optimal visualization of the mesenteric vessels during lateral or oblique views, without compromise in surgical access of the upper extremity vessels or unintentional injury to the brachial plexus and peripheral nerves." [note 1]
Our team are incredibly pleased to have come across this independent clinical investigation on the "Evaluation of Safety of Overhead Upper Extremity Positioning During Fenestrated–Branched Endovascular Repair of Thoracoabdominal Aortic Aneurysms", validating the safety of using an overhead extremity position for optimal visualisation of the mesenteric vessels.
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Key Takeaways
> The commonly used anatomical position is used to reduce risk of inadvertent nerve compression or stretch injuries during operations, resulting in suboptimal imaging resolution during lateral or oblique views
> This study was then conducted to address the initial concern that prolonged operations with overhead upper extremity elevation could be associated with risk of nerve injury despite providing optimal imaging resolution in oblique or lateral views
> 44 patients were positioned with elevated upper extremities above the head, with the elbows positioned forward and upward, avoiding > 90° abduction
> Patients with limited mobility were excluded from the study
> All patients had satisfactory imaging quality
> No brachial plexus or peripheral nerve injuries observed
> The effective radiation dose in this study (1.3± 0.6 Gy) was substantially less than that reported in their prior reports (2.1± 1.8 Gy) [note 2]
> This technique has since been incorporated by the authors for all patients who require complex procedures, excluding patients with limited mobility
Other Noteworthy Comments
> Cadaver dissection studies have found that elevation of the elbows with limited arm abduction to less than 90° reduces brachial plexus stretching and risk of brachial plexus injury from sternal retraction during cardiovascular procedures
> The most recent ASA clinical practice guidelines did not find conclusive evidence that brachial plexus neuropathy is associated with overhead upper extremity positioning during operations, provided arm abduction is limited to ≤ 90
> Since the completion of this pilot study, the authors have progressed to using a supporting device to facilitate the overhead upper extremity positioning (Fig. 1 C)
> Computed tomography angiography (CTA) with upper extremity elevation significantly decreases radiation dose and image noise while improving diagnosis capability, especially in the abdominal region
> While no brand names were mentioned, our iconic Overhead Arm Support design (the Seagull) does seem to appear on Fig. 1C
A note about the Adept Medical Overhead Arm Support
When using an overhead upper extremity positioning with our Adept Medical Overhead Arm Support, keep in mind the patient age, weight, mobility, and duration of procedure, as the product may contribute to brachial plexus injury. [note 4] It is not to be used with patients with existing or historical brachial plexus injury. Ensure IFU is read prior to use.
