Branham sign
Description
Nicoladoni-Israel-Branham sign: Compression of the arterial supply to an arteriovenous fistula causes a decrease in pulse and increase in blood pressure if there is a significant circulation through the fistula.
History of Nicoladoni-Israel-Branham sign
1875 – Carl Nicoladoni (1847-1902) described a case of phlebarteriectasia of the right arm in a 17-year-old worker, which had developed since the age of eight involving the arterial system of the whole right upper extremity. He noted the phenomenon of a slowing down of the pulse, when the brachialis was compressed.
Nicoladoni, 1875: 268
1877 – James Adolf Israël (1848-1926) published his paper on Angiectasie im Stromgebiete der A. tibilais antica. Beobachtung einiger bemerkenswerther Phaenomene nach Unterbindung der A. femoralis, the observation of some remarkable phenomena after ligation of the femoral artery in a case of tibial arterial AV malformation. In particular, on March 16th, after ligation of the femoral artery the pulse dropped from 108 to 42 bpm
Original
English
Es wird aus dem Folgenden hervorgehen, dass die Unterbindung der Femoralis eine Ueberfüllung der Herzhöhlen begünstigen musste. Denn der Effect der Unterbindung bestand, wie dargethan werden wird, 1) in stärkerer Füllung des Gefässystems, 2) in Steigerung der arteriellen Spannung, 3) in bedeutender Pulsverlangsamung.
From the following we observe that the femoral vessel acts as a reservoir for the heart chambers. The effect of this synergy results in 1. enhanced vascular filing 2. increased arterial blood pressure 3. marked bradycardia…
1890 – Harris Miller Branham (1862-1936) reported a case of aneurysmal varix of the femoral artery and vein following a gunshot wound, and noted slowing of the heart rate if he occluded the femoral artery above the varix. In his own words:
The most mysterious phenomenon connected with the case, one which I have not been able to explain myself, or to obtain a satisfactory reason for from others, was slowing of the heart’s beat, when compression of the common femoral was employed.
This symptom became more marked until pressure on the artery above the wound caused the heart’s beat to fall from 80 to 35 per minute, and so to remain until the pressure was relieved
Branham 1890
1914 – Sign rediscovered by Wigdorowitsch and published in the Deutsche Medizinische Wochenschrift in 1915
Original
English
Ein bemerkenswertes Reflexphänomen bei einem Aneurysma der A. femoralis. Von Dr. Wigdorowitsch, Russischer Arzt im Gefangenenlazarett Guben.
Der russische Kriegsgefangene O. hat am 24. August 1914 einen Schuß durch das obere Drittel des rechten Oberschenkels erhalten. Die Wunde ist schnell verheilt, dagegen hat sich ein Aneurysma der A. femoralis ausgebildet. Sitz des Aneurysmas wahrscheinlich im unteren Drittel des Scarpaschen Dreiecks. Der Puls ist sonst normal, gut gefüllt, durchschnittlich 72 in der Minute. Drückt man aber die A. femoralis unter dem Ligamentum Pouparti des verwundeten Beinas zusammen, so sinkt der Puls sofort auf 42–45 Schläge. Dasselbe Verfahren am gesunden Beine beeinflußt den Puls nicht.
Die Erscheinung verdient jedenfalls Nachprüfung auch an an- deren Fällen von Aneurysma
A remarkable reflex phenomenon in a femoral artery aneurysm. From Dr. Wigdorowitsch, Russian doctor in the prison hospital in Guben.
The Russian prisoner of war O. was shot through the upper third of his right thigh on August 24, 1914. The wound healed quickly, but an aneurysm of the femoral artery has developed. The aneurysm is probably located in the lower third of the Scarpa triangle. The pulse is otherwise normal, well filled, an average of 72 per minute. But if the femoral artery is compressed under the Poupart ligament of the wounded leg, the pulse immediately drops to 42-45 beats. The same procedure on a healthy leg does not affect the pulse.
In any case, the phenomenon deserves to be examined in other cases of aneurysms as well
1923 – Rudolph Matas (1860-1957) emphasised the systemic effects of arteriovenous aneurysm; called attention to the desirability of delaying repair in order to favour the development of collaterals. He popularised Branham sign, which he believed held not only diagnostic but prognostic value in arteriovenous aneurysm
Branham’s Bradycardiac Reaction…This is by far the most important early sign of cardiovascular disturbance brought about by an arteriovenous fistula and is of great diagnostic significance in all cases in which arteriovenous communication is accessible to compression
Matas, 1923
1940’s – Lewis and Drury (1923) analyzed the response in detail and demonstrated that it was mediated through the vagus and that atropine would abolish the response. They pointed out that the response was stereotyped under standard conditions, and remained unchanged for a considerable period. Nickerson et al confirmed the fact that atropinization can block the change in pulse rate.
The changes in heart rate and output occurring upon temporary compression of an arteriovenous fistula have been studied in a group of 25 patients. In 68 per cent of the patients there was a significant decrease in heart rate (Branham’s sign) which occurred almost immediately upon compression of the fistula and which was blocked by use of atropine.
Nickerson et al 1950
1958 – Howard B. Burchell (1907-2010) studied a group of children with femoral arteriovenous communications created by Janes, for the purpose of increasing leg growth, at the Mayo Clinic in the 1950’s. He found that when the femoral artery above a large arteriovenous fistula in the thigh is occluded, the bradycardic response has an individualized pattern over several years which is reproducible under standardized conditions. As a general rule the maximal response is obtained within one to two seconds or one to two heart beats.
1997 – Somkiat Wattanasirichaigoon and Frank B. Pomposelli, Jr proposed that Branham sign is an exaggerated Bezold-Jarisch reflex
Associated Persons
- Carl Nicoladoni (1847-1902)
- James Adolf Israël (1848-1926)
- Harris Miller Branham (1862-1936)
- Rudolph Matas (1860-1957)
Alternative names
- Branham’s Bradycardiac reaction (Matas 1923)
- Nicoladoni-Branham sign (Burchell 1958)
- Nicoladoni-Israel-Branham sign
- Branham’s sign
- Nicoladoni sign
References
Historical references
- Nicoladoni C. Phlebarteriectasie der rechten oberen Extremität. Archiv für klinische chirurgie. 1875; 18: 252-273 [Summary: Zentralblatt für Chirurgie 1875; 2: 534-535]
- Israel JA. Aus dem jüdischen Krankenhause zu Berlin. Angiectasie im Stromgebiete der A. tibilais antica. Beobachtung einiger bemerkenswerther Phaenomene nach Unterbindung der A. femoralis. Archiv für klinische chirurgie. 1877; 21: 109-131
- Branham HH. Aneurismal varix of the femoral artery and vein following a gunshot wound. International Journal of Surgery 1890; 3: 250-251
- Wigdorowitsch H. Ein bemerkenswertes Reflexphänomen bei einem Aneurysma der A. femoralis. Deutsche Medizinische Wochenschrift 1915; 41(24): 711
Eponymous term review
- Matas R. Branham’s Bradycardiac reaction. In: On the Systemic or Cardiovascular Effects of Arteriovenous Fistulae: A General Discussion Based upon the Author’s Surgical Experience, Transactions of the Southern Surgical Association 1923; 36: 623-682
- Lewis T, Drury AN. Observations Relating to Arteriovenous Aneurysm: Circulatory Manifestations in Clinical Cases with Particular Reference to Arterial Phenomena of Aortic Regurgitation. Heart 1923; 10: 301-363
- Kennedy JA, Burwell CS. Measurements of the circulation in a patient with multiple arteriovenous connections. American Heart Journal, 1944; 28(2): 133-148
- Nickerson JL, Elkin DC, Warren JV. The effect of temporary occlusion of arteriovenous fistulas on heart rate, stroke volume, and cardiac output. J Clin Invest. 1951 Feb;30(2):215-9
- Burchell H. Observations on bradycardia produced by occlusion of an artery proximal to an arteriovenous fistula (Nicoladoni-Branham‘s sign). Medical Clinics of North America 1958; 42(4): 1029-1035
- Graff LG, Frederick DS, Singh JB. Branham’s sign revisited. N Engl J Med. 1977 Sep 1;297(9):509.
- Sealy WC. Classics in thoracic surgery. On the care and preservation of eponyms: the case of Branham’s sign. Ann Thorac Surg. 1985 Sep;40(3):311-314.
- Hurst JW. Harris H. Branham. Clin Cardiol. 1986 Nov;9(11):589-90.
- Wattanasirichaigoon S, Pomposelli FB Jr. Branham’s sign is an exaggerated Bezold-Jarisch reflex of arteriovenous fistula. J Vasc Surg. 1997 Jul;26(1):171-2.
- Sharma A, Swan KG. Branham’s bradycardic reaction. Ann Vasc Surg. 2010 Feb;24(2):295-8.
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Eponym
the person behind the name
