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Hanif H, Clark R, Moore S, Morrell NT, Marek J, Rana MA, Guliani S. Long-Term Outcomes of Open and Endovascular Axillosubclavian Interventions After Traumatic Injury Reveal High Rates of Limb Dysfunction. Ann Vasc Surg 2023; 97:392-398. [PMID: 37236534 DOI: 10.1016/j.avsg.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/30/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Arterial axillosubclavian injuries (ASIs) are currently managed with open repair (OR) and endovascular stenting (ES). The long-term prognosis of patients with these and associated brachial plexus injuries is poorly understood. We hypothesize that OR and ES for ASI have similar long-term patency rates and that brachial plexus injuries would confer high long-term morbidity. METHODS All patients at a level-1 trauma center who underwent procedures for ASI over a 12-year period (2010 to 2022) were identified. Long-term outcomes of patency rates, types of reintervention, rates of brachial plexus injury, and functional outcomes were then investigated. RESULTS Thirty-three patients underwent operations for ASI. OR was performed in 72.7% (n = 24) and ES in 27.3% (n = 9). ES patency was 85.7% (n = 6/7) and OR patency was 75% (n = 12/16), at a median follow-up of 20 and 5.5 months respectively. In subclavian artery injuries, ES patency was 100% (n = 4/4) and OR patency was 50% (n = 4/8) at a median follow-up of 24 and 12 months respectively. Long-term patency rates were similar between OR and ES (P = 1.0). Brachial plexus injuries occurred in 42.9% (n = 12/28) of patients. Ninety percent (n = 9/10) of patients with brachial plexus injuries who were followed postdischarge had persistent motor deficits at median follow-up of 12 months, occurring at significantly higher rates in patients with brachial plexus injuries (90%) compared to those without brachial plexus injuries (14.3%) (P = 0.0005). CONCLUSIONS Multiyear follow-up demonstrates similar OR and ES patency rates for ASI. Subclavian ES patency was excellent (100%) and prosthetic subclavian bypass patency was poor (25%). brachial plexus injuries were common (42.9%) and devastating, with a significant portion of patients having persistent limb motor deficits (45.8%) on long-term follow-up. Algorithms to optimize brachial plexus injuries management for patients with ASI are high-yield, and likely to influence long-term outcomes more than the technique of initial revascularization.
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Affiliation(s)
- Hamza Hanif
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Ross Clark
- Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Sarah Moore
- Division of Acute Care Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Nathan T Morrell
- Department of Orthopedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM
| | - John Marek
- Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Muhammad Ali Rana
- Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Sundeep Guliani
- Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM; Division of Acute Care Surgery, University of New Mexico School of Medicine, Albuquerque, NM
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Góes AMDO, Parreira JG, Kleinsorge GHD, Dalio MB, Alves PHF, Gomes FJSDDV, de Araujo WJB, Joviliano EE, de Oliveira JCP. Brazilian guidelines on diagnosis and management of traumatic vascular injuries. J Vasc Bras 2023; 22:e20230042. [PMID: 38021277 PMCID: PMC10647898 DOI: 10.1590/1677-5449.202300422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/15/2023] [Indexed: 12/01/2023] Open
Abstract
Trauma is a leading cause of death, permanent disability, and health care cost worldwide. The young and economically active are the most affected population. Exsanguination due to noncompressible torso hemorrhage is one of the most frequent causes of early death, posing a significant challenge to trauma and vascular surgeons. The possibility of limb loss due to vascular injuries must also be considered. In recent decades, the approach to vascular injuries has been significantly modified. Angiotomography has become the standard method for diagnosis, endovascular techniques are currently incorporated in treatment, and damage control, such as temporary shunts, is now the preferred approach for the patients sustaining physiological derangement. Despite the importance of this topic, few papers in the Brazilian literature have offered guidelines on vascular trauma. The Brazilian Society of Angiology and Vascular Surgery has developed Projetos Diretrizes (Guideline Projects), which includes this publication on vascular trauma. Since treating trauma patients is a multidisciplinary effort, the Brazilian Trauma Society (SBAIT) was invited to participate in this project. Members of both societies reviewed the literature on vascular trauma management and together wrote these guidelines on vascular injuries of neck, thorax, abdomen, and extremities.
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Affiliation(s)
- Adenauer Marinho de Oliveira Góes
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Centro Universitário do Pará - CESUPA, Faculdade de Medicina, Belém, PA, Brasil.
- Universidade Federal do Pará - UFPA, Faculdade de Medicina, Belém, PA, Brasil.
| | - José Gustavo Parreira
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia, São Paulo, SP, Brasil.
| | - Gustavo Henrique Dumont Kleinsorge
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Fundação Hospitalar do Estado de Minas Gerais - FHEMIG, Clínica de Cirurgia Vascular, Hospital João XXIII, Belo Horizonte, MG, Brasil.
| | - Marcelo Bellini Dalio
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Divisão de Cirurgia Vascular e Endovascular, Hospital das Clínicas, Ribeirão Preto, SP, Brasil.
| | - Pedro Henrique Ferreira Alves
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Faculdade de Medicina, Hospital das Clínicas, III Clínica Cirúrgica, São Paulo, SP, Brasil.
| | - Francisco João Sahagoff de Deus Vieira Gomes
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Universidade do Estado do Rio de Janeiro - UERJ, Faculdade de Ciências Médicas, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
- Polícia Militar do Estado do Rio de Janeiro - PMERJ, Rio de Janeiro, RJ, Brasil.
| | - Walter Junior Boim de Araujo
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade Federal do Paraná - UFPR, Hospital das Clínicas, Divisão de Angiorradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Divisão de Cirurgia Vascular e Endovascular, Hospital das Clínicas, Ribeirão Preto, SP, Brasil.
| | - Julio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
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He W, Pan J. Concurrent Spinal Trauma in Patients with Traumatic Head Injury: A Seven-Year Retrospective Analysis. Med Sci Monit 2023; 29:e939215. [PMID: 37596775 PMCID: PMC10445503 DOI: 10.12659/msm.939215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/28/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Assessing spinal injuries in patients with traumatic head injuries is crucial due to their potential to alter functionality and increase mortality rates. This single-center retrospective study was conducted to understand the prevalence and characteristics of concurrent spinal injuries in adults with traumatic head injury from April 2015 to April 2022. MATERIAL AND METHODS The study incorporated demographic, clinical, traumatological, and hemodynamic data from 1,501 adult patients presenting with traumatic head injuries. Spinal injuries were identified through symptoms, physical signs, and radiological findings. RESULTS During the study period, 179 patients (12%) were reported with associated spinal injuries. These patients were predominantly male (p=0.0012), aged 65 years or above (p=0.0452), had thoracic injuries (p=0.0004), and arrived at the emergency department more than three hours post-trauma (p=0.0004). Most injuries were caused by motor vehicle accidents (p=0.0412) or falls from heights greater than 3 meters (p=0.0481). In addition, these patients had higher Abbreviated Injury Scale scores (≥2, p=0.0391), Eppendorf-Cologne Scale scores (≥2, p=0.0412), and lower systolic and diastolic blood pressure readings (p=0.0481, p=0.0412) along with lower heart rates (p=0.0482). However, no correlation was found between systolic and diastolic pressures and age among patients with spinal injuries. CONCLUSIONS This study reveals that the prevalence and severity of spinal injuries in patients with traumatic head injuries are influenced not only by demographic and clinical parameters, but also by the degree and extent of head trauma.
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Barabino E, Ivaldi D, Pittaluga G, Nivolli A, Arnò M, Gazzo P. The spectrum of computed tomography findings in blunt trauma of the subclavian/axillary artery: a pictorial essay. Diagn Interv Radiol 2023; 29:117-127. [PMID: 36960559 PMCID: PMC10679581 DOI: 10.5152/dir.2022.211271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/16/2022] [Indexed: 01/15/2023]
Abstract
Traumatic injuries of the subclavian and axillary arteries are uncommon but have high morbidity and mortality. In contrast to penetrating injuries, which are often lethal, blunt injuries present a wide and heterogeneous spectrum of imaging findings. If a vessel tear or transsection is a life-threatening circumstance, minor injuries might be overlooked in an emergency setting but could cause or aggravate the functional loss of a limb. The aim of this pictorial essay is to acquaint radiologists with the spectrum of imaging findings that could be encountered during the radiological evaluation of the subclavian/axillary artery (SAA) in trauma patients and offer tips and tricks to improve the diagnostic workup of patients with suspected blunt SAA injuries.
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Affiliation(s)
- Emanuele Barabino
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Diego Ivaldi
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Giulia Pittaluga
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Arianna Nivolli
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Matteo Arnò
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Paolo Gazzo
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
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Barmparessos E, Katsikas V, Gravanis M, Kalamaras A, Kopadis G. Combination of endovascular and open repair for the management of subclavian artery injury. Trauma Case Rep 2022; 41:100673. [PMID: 35844963 PMCID: PMC9283655 DOI: 10.1016/j.tcr.2022.100673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 10/28/2022] Open
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Chaudhry IUH, M Al Fraih O, A Al Abdulhai M, Al Maimon H, A Alqahtani Y, Tariq khan M, M Al Ghamdi A. Cardiac arrest secondary to subclavian artery injury in blunt chest trauma: A lifesaving emergency surgery in COVID crises. Ann Med Surg (Lond) 2022; 75:103454. [PMID: 35386770 PMCID: PMC8977998 DOI: 10.1016/j.amsu.2022.103454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
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Liakhovskyi VI, Honcharov AV, Kovaliov OS. ASPECTS OF PREDICTION OF VASCULAR DISORDERS IN HUMERUS FRACTURES. BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2022. [DOI: 10.29254/2077-4214-2022-3-166-216-219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hazra D, Kota AA, Raj SP, Premkumar P, Selvaraj AD, Agarwal S, Thomas BP. Does endovascular repair of post-traumatic thoracic vascular injury of the subclavian/axillary arteries followed by brachial plexus injury improve outcome? Indian J Thorac Cardiovasc Surg 2021; 38:294-299. [PMID: 35528997 PMCID: PMC9023618 DOI: 10.1007/s12055-021-01278-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/25/2022] Open
Abstract
Traumatic injuries to the axillary artery or subclavian artery along with a brachial plexus injury are infrequent. Although the traditional management has been conservative because of robust collaterals, the functional improvement of the limb depends on the degree of brachial plexus injury and on the revascularization status. We report three cases of endovascular repair post-traumatic axillo-subclavian artery injuries followed by brachial plexus injury with good functional outcomes. Endovascular repair of post-traumatic subclavian and axillary artery injuries followed by brachial plexus injury is safe and feasible, and improves limb outcomes.
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Affiliation(s)
- Darpanarayan Hazra
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Albert Abhinay Kota
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Sam Pon Raj
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Prabhu Premkumar
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Andrew Dheepak Selvaraj
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Sunil Agarwal
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Binu Prathap Thomas
- Department of Hand and Leprosy Reconstructive Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
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Góes AMDO, Maurity MP, do Amaral CAC. Damage control for subclavian artery injury. J Vasc Bras 2021; 19:e20200007. [PMID: 34290751 PMCID: PMC8276654 DOI: 10.1590/1677-5449.200007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/18/2020] [Indexed: 11/22/2022] Open
Abstract
Mortality from penetrating traumas involving the subclavian vessels can be as high as 60% in pre-hospital settings. Operating room mortality is in the range of 5-30%. This paper presents a case in which a strategy for damage control was employed for a patient with an injury to the origin of the left subclavian artery, using subclavian ligation, with no need for any other intervention, and maintaining viability of the left upper limb via collateral circulation. The authors also review surgical approaches and treatment strategies with a focus on damage control in subclavian vessel injuries.
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Affiliation(s)
- Adenauer Marinho de Oliveira Góes
- Cirurgia Vascular, Hospital Metropolitano de Urgência e Emergência - HMUE, Ananindeua, PA, Brasil.,Faculdade de Medicina, Universidade Federal do Pará - UFPA, Belém, PA, Brasil
| | - Mariana Pereira Maurity
- Cirurgia Geral, Hospital Metropolitano de Urgência e Emergência - HMUE, Ananindeua, PA, Brasil
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Boukobza M, Laissy JP. Follow-up imaging in severe cerebral vasospasm secondary to SAH and subclavian-vertebral artery dissection after mild trauma. Neurochirurgie 2020; 66:490-493. [PMID: 33058903 DOI: 10.1016/j.neuchi.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/27/2020] [Accepted: 09/02/2020] [Indexed: 11/20/2022]
Affiliation(s)
- M Boukobza
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat University Hospital, 75018 Paris, France.
| | - J-P Laissy
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat University Hospital, 75018 Paris, France; INSERM U1148, Paris, France; University Paris 7, Bichat Hospital, Paris, France
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Warren KRJ, Balogh ZJ. Major vascular trauma. Eur J Trauma Emerg Surg 2019; 45:941-942. [PMID: 31811334 DOI: 10.1007/s00068-019-01267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kirrily -Rae J Warren
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
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Penetrating Subclavian Artery Injuries: Recent Challenges with Variable Solutions. Am Surg 2019. [DOI: 10.1177/000313481908500811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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