1
|
Hwang S, Kim GW, Cho SH, Hwang D, Lim KH. Subclavian arterial rupture due to blunt trauma injury: A case report. Medicine (Baltimore) 2024; 103:e38775. [PMID: 38996154 PMCID: PMC11245232 DOI: 10.1097/md.0000000000038775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
RATIONALE Subclavian arterial injury due to blunt trauma is rare but can have devastating outcomes. Massive hemorrhage or limb ischemia might develop depending on the extent of damage, and open repair might be necessary to salvage the limb. However, life-saving treatments should be prioritized in critically unstable patients. PATIENT CONCERNS A 21-year-old male patient who was transferred to our trauma center following a motorcycle accident. Abdominal and chest computed tomography (CT) revealed right renal injury and massive hemothorax with several rib fractures in the right chest. DIAGNOSIS AND INTERVENTIONS Right renal injury with multiple extravasations and right 8th intercostal arterial injury were detected during angiography. Emergent exploration with lateral thoracotomy was performed to manage right hemothorax. Pulsating bleeding from the thoracic roof observed in the operative field suggested a subclavian arterial injury. The unstable vital signs did not recover despite massive transfusion, and his right arm had already stiffened. Therefore, endovascular approach was adopted and the second portion of the right subclavian artery was embolized using microcoils and thrombin. OUTCOMES Postoperative intensive care unit management performed to resuscitate patient from multiorgan failure included continuous renal replacement therapy (CRRT). After confirming the demarcation lines, transhumeral amputation of the right arm was performed on admission day 12. The patient recovered from multiorgan failure for more than 3 weeks after the accident; however, the patient survived. LESSONS Limb salvage, albeit critical for quality of life, is not possible in some cases where life-saving measures require its sacrifice. In these cases, quick decision-making by the surgeon is paramount for patient survival. As illustrated in this case, endovascular approaches should be considered less invasive measures to save the patient's life.
Collapse
Affiliation(s)
- Suyeong Hwang
- Division of Trauma and Critical Care, Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gun Woo Kim
- Division of Trauma and Critical Care, Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sung Hoon Cho
- Division of Trauma and Critical Care, Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Deokbi Hwang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University, Daegu, Republic of Korea
| | - Kyoung Hoon Lim
- Division of Trauma and Critical Care, Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| |
Collapse
|
2
|
Kim GW, Hwang S, Lim KH, Cho SH. Endovascular treatment for 2 types of subclavian artery injury: A case report. Medicine (Baltimore) 2024; 103:e38892. [PMID: 38996150 PMCID: PMC11245228 DOI: 10.1097/md.0000000000038892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/05/2024] [Indexed: 07/14/2024] Open
Abstract
RATIONALE Subclavian artery (SCA) injuries, though rare, carry significant morbidity and mortality risks due to significant blood loss causing hypovolemic shock. Early diagnosis and adequate treatment are crucial to minimize bleeding and associated morbidity. Recent advances in endovascular techniques offer faster and more accurate treatment options compared to traditional open surgical repair. This study demonstrates the efficacy of endovascular treatment in 2 cases of SCA injury and reviews its indications, limitations, and precautions. PATIENT CONCERNS A 69-year-old man presented with a penetrating SCA injury from a steel bar, and a 38-year-old woman presented with a blunt SCA injury caused by a fall. Both patients were hemodynamically unstable upon presentation. DIAGNOSES Both patients were diagnosed with SCA injuries. The man had a penetrating injury, while the woman had a blunt injury, both resulting in hemodynamic instability and significant risk of hypovolemic shock. INTERVENTIONS Endovascular techniques, including the use of covered stent grafts, were employed to manage the injuries. These techniques allowed for rapid and efficient treatment, reducing the need for open surgical intervention. OUTCOMES Both patients were successfully treated using endovascular methods and were discharged without any complications. The endovascular approach minimized blood loss, transfusion needs, and hospital stay. LESSONS This study demonstrates the effectiveness of endovascular techniques in rapidly diagnosing, bridging, and definitively treating SCA injuries, suggesting their use as a first-line therapy.
Collapse
Affiliation(s)
- Gun Woo Kim
- Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Suyeong Hwang
- Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyoung Hoon Lim
- Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Hoon Cho
- Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
3
|
Lawson J, Crockett S, Griffiths D, Riga C, Sabharwal S, Thomas R, Das R. Ruptured subclavian artery pseudoaneurysm following a shoulder massage on a background of clavicle non-union. BMJ Case Rep 2023; 16:e253826. [PMID: 37402587 PMCID: PMC10335590 DOI: 10.1136/bcr-2022-253826] [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] [Indexed: 07/06/2023] Open
Abstract
We present an unusual case of ruptured subclavian artery pseudoaneurysm following hydrotherapy and shoulder massage session on a background of clavicle non-union.Following a clavicle fracture 16 years ago, which was managed conservatively, a woman in her 30s presents over a decade later with a ruptured subclavian artery pseudoaneurysm.The original midshaft clavicle fracture was sustained 16 years ago. Conservative management was agreed, and she was discharged. Six years ago, she developed a small subclavian artery pseudoaneurysm which was kept under surveillance for 12 months with no active intervention required.Over the following years, she continued to have intermittent shoulder girdle discomfort and neuropathic symptoms. On this presentation, after a sports massage, she presented with rapid-onset supraclavicular and axillary swelling. This was diagnosed as a ruptured subclavian artery pseudoaneurysm and was treated with emergency radiological-guided stenting and subsequent internal fixation of the clavicle non-union.The patient then attended regular orthopaedic and vascular follow-up to ensure her clavicle fracture unites and the graft remains patent.We discuss the case presentation and management of this unusual injury.
Collapse
Affiliation(s)
- Jason Lawson
- Vascular Surgery, St Mary's Hospital, London, UK
| | | | | | - Celia Riga
- Vascular Surgery, St Mary's Hospital, London, UK
| | | | - Robert Thomas
- Interventional Radiology, St Mary's Hospital, London, UK
| | - Rishi Das
- Trauma & Orthopaedics, St Mary's Hospital, London, UK
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
| |
Collapse
|
4
|
Patousis A, Sachinis NP, Yiannakopoulos C, Givissis P. Axillary Artery Injury and By-Pass Restoration After Open Reduction of a Chronic Shoulder Dislocation: A Case Report. Cureus 2022; 14:e23594. [PMID: 35505720 PMCID: PMC9053552 DOI: 10.7759/cureus.23594] [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: 03/28/2022] [Indexed: 11/05/2022] Open
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
Chen HY, Zhao F, Qin JY, Lin HM, Su JP. Malignant meningioma with jugular vein invasion and carotid artery extension: A case report and review of the literature. World J Clin Cases 2020; 8:6110-6121. [PMID: 33344612 PMCID: PMC7723712 DOI: 10.12998/wjcc.v8.i23.6110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/22/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Grade II and III meningiomas [World Health Organization (WHO) classification] rarely have extracranial metastases via the blood circulation; however, we experienced a case with a metaplastic atypical meningioma and local de-differentiation that metastasized to the jugular vein, carotid artery and subclavian artery at the cervicothoracic junction. Such cases have seldom been reported before.
CASE SUMMARY The patient was a 30-year-old man who developed right neck masses with dysphagia, labored breathing, dizziness, and occasional earaches. Eight months earlier the patient was diagnosed with a right parietal lobe neoplasm and hemorrhage at a local hospital due to the sudden onset of headaches and left limb weakness, and the post-operative pathology was a metaplastic atypical meningioma (WHO grade II) with local de-differentiation (WHO III). Magnetic resonance imaging revealed a calcified mass at the root of the neck on the right and a large cystic mass in the right parapharyngeal space. Head and neck angiography showed that the right common carotid artery was compressed and completely occluded, and the jugular vein was enveloped by the tumor and occluded. A balloon occlusion test showed no perfusion in the right common carotid artery. Tumor resection, carotid artery ligation, and subclavian artery reconstruction were performed. The tumor was a malignant meningioma. Post-operatively, the patient had Horner's syndrome and hoarseness.
CONCLUSION This case highlights the importance of the link between a large cervical mass and a primary intracranial tumor. Malignant meningioma should not be considered merely as an intracranial metastasis spread through cerebrospinal fluid, it can also be transferred through the circulation to the parapharyngeal space and the cervical great vessels.
Collapse
Affiliation(s)
- Hui-Ying Chen
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Feng Zhao
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jiang-Yuan Qin
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hai-Mei Lin
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ji-Ping Su
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| |
Collapse
|
7
|
Tay E, Grigorian A, Schubl SD, Lekawa M, de Virgilio C, Scolaro J, Kabutey NK, Nahmias J. Brachial Plexus Injury Significantly Increases Risk of Axillosubclavian Vessel Injury in Blunt Trauma Patients With Clavicle Fractures. Am Surg 2020; 87:747-752. [PMID: 33169619 DOI: 10.1177/0003134820952832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A national analysis of clavicle fractures is lacking and the risk of concomitant axillosubclavian vessel injury (ASVI) in patients with clavicle fractures is unknown. A minority of patients may have a combined brachial plexus injury (BPI). We sought to describe risk factors for concomitant ASVI in patients with a clavicle fracture; hypothesizing patients with combined clavicle fracture and BPI has a higher risk of ASVI. METHODS The Trauma Quality Improvement Program (2010-2016) was queried for blunt trauma patients with a clavicle fracture. A multivariable logistic regression model was used to determine risk factors for ASVI. A subset analysis on patients with isolated clavicle fractures was additionally performed. RESULTS From 59 198 patients with clavicle fractures, 341 (.6%) had concomitant ASVI. Compared to patients without ASVI, patients with ASVI had a higher median injury severity score (24 vs. 17, P < .001) and rates of pulmonary contusions (43.4% vs. 37.7%, P = .029) and BPI (18.2% vs. .4%, P < .001). After controlling for associated chest wall injuries and humerus fracture, the BPI odds ratio (OR 49.17, 35.59-67.92, P < .001) was independently associated with risk for ASVI. In a subset analysis of isolated clavicle fractures, BPI remained associated with risk of ASVI (OR 60.01, confidence intervals 25.29-142.39, P < .001). CONCLUSION The rate of concomitant ASVI in patients with a clavicle fracture is <1%. Patients presenting with a clavicle fracture had a high rate of injuries including pulmonary contusion. Patients with findings suggestive of underlying BPI had a nearly 50 times increased associated risk of ASVI. Thus, a detailed physical exam in this setting including brachial-brachial index appears warranted.
Collapse
Affiliation(s)
- Erika Tay
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, CA, USA
| | - Areg Grigorian
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, CA, USA
| | - Sebastian D Schubl
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, CA, USA
| | - Michael Lekawa
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, CA, USA
| | | | - John Scolaro
- Department of Orthopedics, University of California, CA, USA
| | - Nii-Kabu Kabutey
- Department of Surgery, Division of Vascular Surgery, University of California, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, CA, USA
| |
Collapse
|
8
|
Derbel B, Ziadi J, Daoud Z, Souiden S, Miri R, Ben Mrad M, Ghedira F, Ben Omrane S, Denguir R. [Arterial trauma of the upper limbs: Particularities of the population in Tunisia and risk factors for amputation]. Ann Cardiol Angeiol (Paris) 2020; 70:41-46. [PMID: 32859358 DOI: 10.1016/j.ancard.2020.03.015] [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: 08/07/2019] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY The purpose of our study was to review the population at risk of upper limb arterial injury, to determinate the rate of upper limb salvage and the predictive factors of limb loss. METHODS This was a retrospective study, involving 128 patients with upper extremity arterial trauma operated between January first, 2006 and June 30, 2017. Exclusion criteria were arterial ligation, primary limb amputation and arterial iatrogenic injuries. End points were immediate technical success, primary patency and limb salvage rate. RESULTS The average age was 27.7 years with a sex ratio M/F=41, causes of trauma were self-inflicted wounds (51%), assaults (23%), road traffic accidents (10%), work accidents (9%) and domestic accidents (7%). Injured arteries were brachial (66.5%) usually because of self-inflicted injuries; arteries of the forearm (31%) and axillery arteries (2.5%). The techniques of arterial repair were vein graft interposition in 52% of cases, end-to-end anastomosis in 23%, primary arterial repair in 21% and venous patch in 4%. Eight reconstructions occluded during the first week (6.25%). Four patients required secondary amputation and limb salvage rate was 96.8%. After a median follow-up time of 62 days, only 21% were followed at 3 months. Mechanism of injury, soft tissue loss and arterial reconstruction thromboses were selected as factors influencing the rate of limb salvage. One death occurred at day 14 secondary to multi-component poly-trauma. CONCLUSION Prompt diagnosis, appropriate multidisciplinary management of the upper extremity arterial trauma and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage. Associated soft tissue injury is a poor limb salvage factor.
Collapse
Affiliation(s)
- B Derbel
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - J Ziadi
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - Z Daoud
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie.
| | - S Souiden
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - R Miri
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - M Ben Mrad
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - F Ghedira
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - S Ben Omrane
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - R Denguir
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| |
Collapse
|
9
|
Shaikh S, Boneva D, Hai S, McKenney M, Elkbuli A. Ballistic Axillary Vein Transection: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1869-1873. [PMID: 31836697 PMCID: PMC6930707 DOI: 10.12659/ajcr.919090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Male, 25-year-old Final Diagnosis: Axillary vein transection Symptoms: Shortness of breath Medication: — Clinical Procedure: Ligation of the axillary vein Specialty: Surgery
Collapse
Affiliation(s)
- Saamia Shaikh
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Shaikh Hai
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| |
Collapse
|
10
|
Demir D, Borger van der Burg B, Stollenwerck G, Hoencamp R. Subclavian artery occlusion after a clavicle fracture. BMJ Case Rep 2019; 12:12/11/e229314. [PMID: 31722869 DOI: 10.1136/bcr-2019-229314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 44-year-old man with a 9-day-old left displaced midshaft clavicle fracture was initially treated conservatively. The patient experienced an increase of pain with tickling and cold sensation in the left upper extremity. CT angiography showed left subclavian artery occlusion over 3 cm at the level of the fracture. At surgical repair, a subclavian-brachial bypass was constructed and fracture fixation was done with an eight-hole locking compression plate. Follow-up at 6 months showed full range of motion of the left shoulder, an open bypass and fracture consolidation.
Collapse
Affiliation(s)
- Diba Demir
- Department of Surgery, Alrijne Ziekenhuis Locatie Leiderdorp, Leiderdorp, The Netherlands
| | | | - Guido Stollenwerck
- Department of Surgery, Alrijne Ziekenhuis Locatie Leiderdorp, Leiderdorp, The Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Ziekenhuis Locatie Leiderdorp, Leiderdorp, The Netherlands.,Trauma Research Unit, Department of Surgery, ErasmusMC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Defense Healthcare Department, Ministry of Defence, Utrecht, The Netherlands
| |
Collapse
|
11
|
Angus LDG, Gerber N, Munnangi S, Wallace R, Singh S, Digiacomo J. Management and Outcomes of Isolated Axillary Artery Injury: A Five-Year National Trauma Data Bank Analysis. Ann Vasc Surg 2019; 65:113-123. [PMID: 31678544 DOI: 10.1016/j.avsg.2019.10.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/20/2019] [Accepted: 10/19/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study is to evaluate recent national trends in the clinical characteristics, management, and outcomes of patients with isolated axillary artery injuries. METHODS The National Trauma Data Bank was queried to identify records submitted from 2011 to 2015 that contained an ICD-9-CM diagnosis code for an injury to axillary artery (903.01) and an external cause of injury code indicating blunt or penetrating trauma. Records that contained a diagnosis code for an injury to an additional blood vessel (900.00-903.00, 903.2-904.9), an injury to a nonupper extremity or unclassifiable body region, or whose operative management could not be discerned were excluded. The final study sample included 221 patients with isolated axillary artery injury. The patient's clinical management was the primary outcome of interest. The study sample was stratified by trauma type, and descriptive statistics were performed on all variables. RESULTS Seventy-one percent of patients received operative management. Patients with penetrating injury were 24% more likely to be managed operatively than bluntly injured patients (76.9% vs. 62.1%, P = 0.0178). In operatively managed patients, the open repair rate was 82.8% and endovascular repair rate was 10.2%. Graft repair was performed most often (28.0%), followed by placement of a temporary intravenous shunt (17.8%) and surgical occlusion (10.2%). Surgical vessel occlusion was significantly more likely to be performed on patients with penetrating injury than with blunt injury (14.6% vs. 1.9%, P = 0.0124). Patients with penetrating injury had significantly shorter median emergency department length of stay (87.0 min vs. 152.0 min, P < 0.0001), intensive care unit length of stay (2.0 days vs. 3.0 days, P < 0.0388), hospital length of stay (4.0 days vs. 5.0 days, P = 0.0026), and time-to-operative management (1.6 hr vs. 3.9 hr, P < 0.001) compared to bluntly injured patients. Patients with blunt injury had a higher reportable in-hospital complication rate (13.8% vs. 6.0%, P = 0.0477). The overall mortality rate was 3.1% for isolated axillary artery injuries and did not significantly differ by trauma type. CONCLUSIONS Axillary artery injury is more often caused by penetrating trauma. Despite introduction of novel endovascular techniques, the majority of patients with isolated axillary artery injury are managed using open repair. Penetrating axillary artery injury is significantly more likely to be managed using open repair and by surgical occlusion. Patients with blunt injury have higher complication rates and longer hospital length of stays. The mortality rate is lower than previously published.
Collapse
Affiliation(s)
- L D George Angus
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Noam Gerber
- Department of Surgery, Nassau University Medical Center, East Meadow, NY.
| | - Swapna Munnangi
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Raina Wallace
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Shridevi Singh
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Jody Digiacomo
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| |
Collapse
|
12
|
Elkbuli A, Shaikh S, McKenney M, Boneva D. Subclavian artery avulsion following blunt trauma: A case report and literature review. Int J Surg Case Rep 2019; 61:157-160. [PMID: 31376736 PMCID: PMC6677780 DOI: 10.1016/j.ijscr.2019.07.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022] Open
Abstract
Subclavian artery injuries are rare, highly fatal, and constitute less than 2% of all vascular injuries. Surgical repair of these injuries can be technically challenging due to their anatomic location. Therapeutic approaches include surgical repair, endovascular repair, or a hybrid approach depending on the severity of the injury and the patient’s hemodynamic status.
Introduction Subclavian artery injuries are rare and are associated with a high morbidity and mortality. The majority of patients with blunt trauma to the subclavian artery succumb to their injury before reaching a hospital. In-hospital mortality remains high. Presentation of case We report the case of a 30-year-old male who presented with complete traumatic subclavian artery avulsion after a motorcycle collision. He presented in hemorrhagic shock. Temporary hemostatic control was achieved with endovascular balloon occlusion followed by operative intervention. Discussion Prompt diagnosis and meticulous management including early transfusion, when indicated, are necessary to salvage both the patient’s life and limb from such severe injuries. Intra-operative diagnosis of subclavian artery injury is most common due to the hemodynamic instability of most patients with such injuries; however, conventional angiography and computed tomography angiography are useful diagnostic modalities as well. Temporizing measures such as endovascular balloon occlusion to obtain vascular control may serve as a valuable adjunct to surgical repair. Conclusion Repair of a subclavian artery injury is challenging for even the most experienced of surgeons. Endovascular techniques can be therapeutic or used as an adjunct to control bleeding ad allow an open repair.
Collapse
Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States.
| | - Saamia Shaikh
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| |
Collapse
|
13
|
Sartawi R, Abu-Halimah S, Abdelhamid S, Yanis A. Endovascular Repair of Axillary Artery Transection with a Stent Graft following Blunt Trauma. ACTA ACUST UNITED AC 2019. [DOI: 10.25259/ajir-1-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Transection injuries of the axillary artery are rare and typically involve surgical repair. This case describes an emergent endovascular treatment option, using a stent graft, in a patient that was deemed as high risk for open surgery.
Collapse
Affiliation(s)
- Rami Sartawi
- Department of Interventional Radiology, OMNY Vein and Cardiovascular, New York
| | | | | | - Ahmad Yanis
- School of Medicine, University of Jordan, Amman, Jordan
| |
Collapse
|
14
|
Eighteen years' experience of traumatic subclavian vascular injury in a tertiary referral trauma center. Eur J Trauma Emerg Surg 2019; 45:973-978. [PMID: 30627733 PMCID: PMC6910889 DOI: 10.1007/s00068-018-01070-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/27/2018] [Indexed: 11/09/2022]
Abstract
Purpose Traumatic subclavian vascular injury (TSVI) is rare but often fatal. The precise diagnosis of TSVI remains challenging mainly because of its occult nature, less typical presentations, and being overlooked in the presence of polytrauma. Compared to penetrating injuries, it is even more difficult to identify TSVI in patients who have blunt injuries and no visible bleeding. The risk factors associated with TSVI in patients with thoracic trauma are unclear. The aims of this study were to identify risk factors for TSVI in a cohort of patients with thoracic vascular injuries and to report outcomes after clinical treatment. Methods From January 2009 to June 2017, 39586 patients were admitted to our hospital (a level I trauma center) due to trauma, and 136 patients with thoracic vascular injury were enrolled in this study. We retrospectively reviewed data from medical records including demographic characteristics, injury scoring systems (RTS, ISS, NISS, TRISS and AIS), management and outcomes. Patients were further divided into the TSVI group (patients with TSVI) and the non-TSVI group (patients with thoracic vascular injuries other than TSVI). Univariate and multivariate analyses were used to identify independent risk factors. Results The enrolled 136 patients suffered mostly from blunt trauma (89.0%) and 22 of them had TSVI. When compared to the non-TSVI group, the TSVI group had lower Glasgow Coma Scale (GCS) scores (p = 0.002; especially GCS ≤ 12), less concurrent abdominal injury (p < 0.001), lower Injury Severity Scales (ISS) (p = 0.007) and New Injury Severity Scales (NISS) (p < 0.002) but had higher Abbreviated Injury Scales (AIS) of the head ≥ 3 (p = 0.009) and rates of clavicular or scapular fractures (p = 0.013). No difference was detected between the two groups with regard to age, gender, trauma mechanism, vital signs on arrival, or rate of facial and extremities injury. In multivariate regression analyses, GCS ≤ 12, AIS of the head ≥ 3 and the presence of clavicular or scapular fractures were independent risk factors for TSVI (p = 0.026, p = 0.043 and p = 0.005, respectively) after adjustment for confounding factors. Open and endovascular repair were two surgical procedures utilized for these TSVI patients with an overall mortality rate of 18.2%. No difference was found between these groups with regard to mortality rate and the length of ICU stay, but the patients in the TSVI group had a shorter length of hospital stay. Conclusions Our results suggest that GCS ≤ 12, AIS of the head ≥ 3 and the presence of clavicular or scapular fractures were independent risk factors for TSVI in patients with thoracic vascular injuries. For patients with thoracic trauma, TSVI should be considered for prompt management when patients exhibit concurrent injuries to the head, clavicle or scapula.
Collapse
|
15
|
Intraoperative combination of resuscitative endovascular balloon occlusion of the aorta and a median sternotomy in hemodynamically unstable patients with penetrating chest trauma: Is this feasible? J Trauma Acute Care Surg 2018; 84:752-757. [DOI: 10.1097/ta.0000000000001807] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Bucci G, Lucar-López G, Sanchez-Gonzalez J, Malagelada F, Palencia Lopez J, Guevara-Noriega KA. Axillary artery injury and brachial plexus palsy as a complication of proximal humerus fractures. J Orthop 2017; 14:340-341. [PMID: 28706376 DOI: 10.1016/j.jor.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/21/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- G Bucci
- Hospital de Mataro, Carretera de Cirera, 230, Traumatology Department. 08304 Mataró, Barcelona, Spain
| | - G Lucar-López
- Hospital de Mataro, Carretera de Cirera, 230, Traumatology Department. 08304 Mataró, Barcelona, Spain
| | - J Sanchez-Gonzalez
- Hospital de Mataro, Carretera de Cirera, 230, Traumatology Department. 08304 Mataró, Barcelona, Spain
| | - F Malagelada
- Hospital de Mataro, Carretera de Cirera, 230, Traumatology Department. 08304 Mataró, Barcelona, Spain
| | - J Palencia Lopez
- Hospital de Mataro, Carretera de Cirera, 230, Traumatology Department. 08304 Mataró, Barcelona, Spain
| | - K A Guevara-Noriega
- Hospital de Mataro, Carretera de Cirera, 230, Traumatology Department. 08304 Mataró, Barcelona, Spain
| |
Collapse
|
17
|
Padegimas EM, Schoch BS, Kwon J, DiMuzio PJ, Williams GR, Namdari S. Evaluation and Management of Axillary Artery Injury: The Orthopaedic and Vascular Surgeon’s Perspective. JBJS Rev 2017. [DOI: 10.2106/jbjs.rvw.16.00082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
18
|
Matsagkas M, Kouvelos G, Peroulis M, Xanthopoulos D, Bouris V, Arnaoutoglou E. Endovascular repair of blunt axillo-subclavian arterial injuries as the first line treatment. Injury 2016; 47:1051-6. [PMID: 26905594 DOI: 10.1016/j.injury.2016.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/25/2016] [Accepted: 02/05/2016] [Indexed: 02/02/2023]
Abstract
AIM To report and analyse our results regarding the endovascular management of blunt axillo-subclavian arterial injuries as the first line treatment. METHODS During an eight-year period, seven patients (mean age 56.4±14.1 years, all males) with blunt traumatic axillo-subclavian arterial injuries were presented to the emergency department. All patients suffered also from concomitant other injuries and had a supraclavicular haematoma along with diminished or absent upper limb peripheral pulses, while computed tomography angiography set the diagnosis. RESULTS The endovascular procedure was technically successful in all patients. No procedure-related complication was encountered during the in-hospital stay, while none of the patients died. The median hospital stay was 22 days (range 12-46). During a follow-up period spanning an average of 27 months (range 6-44 months) there was one stent-graft thrombosis at 12 months in an otherwise asymptomatic patient that required no further intervention. CONCLUSION Endovascular technique seems to constitute a reliable approach for treating blunt axillo-subclavian arterial injuries in the emergent setting. Despite uncertainties in patient selection and optimal management algorithms, it seems that endovascular approach could be the first line treatment for such injuries. Accumulation of data on larger number of patients with longer follow-up is warranted to further define the value of this therapeutic modality in the trauma setting.
Collapse
Affiliation(s)
- Miltiadis Matsagkas
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece.
| | - George Kouvelos
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Michalis Peroulis
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios Xanthopoulos
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasilios Bouris
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, School of Medicine, University of Ioannina, Ioannina, Greece
| |
Collapse
|
19
|
Yamazaki H, Akaoka Y, Komatsu M. Percutaneous Transluminal Angioplasty for Axillary Artery Dissection After Open Reduction of Shoulder Fracture-Dislocation: A Case Report. JBJS Case Connect 2015; 5:e46. [PMID: 29252700 DOI: 10.2106/jbjs.cc.n.00148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Injury of the axillary artery after shoulder-joint fracture or dislocation is uncommon. We describe the clinical outcome of an elderly patient with a dissecting aneurysm of the axillary artery following open reduction of a fracture-dislocation of the shoulder. The arterial dissection was successfully managed with percutaneous transluminal balloon angioplasty. CONCLUSION This case report highlights the need for careful vascular examination of all elderly patients with a fracture or dislocation of the shoulder and the possible use of percutaneous transluminal angioplasty for the management of arterial dissection prior to proceeding with surgical exploration.
Collapse
Affiliation(s)
- Hiroshi Yamazaki
- Department of Orthopaedic Surgery, Aizawa Hospital, Honjo 1-5-2, Matsumoto 390-8510, Japan. . .
| | | | | |
Collapse
|
20
|
Labsaili H, Makani S. [Wound of the left subclavian artery by a screwdriver: about a case]. Pan Afr Med J 2014; 18:75. [PMID: 25400842 PMCID: PMC4231247 DOI: 10.11604/pamj.2014.18.75.4281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/07/2014] [Indexed: 11/23/2022] Open
Abstract
Nous rapportons le cas d'un patient présentant une plaie de l'artère sous-clavière gauche suite à un traumatisme par un tournevis. Il s'agit d'une lésion rare mais grave, qui entraine souvent des complications neurologiques et respiratoires pouvant être mortelles. Dans les pays en voie de développement, la chirurgie classique à ciel ouvert reste de premier recours.
Collapse
Affiliation(s)
- Hicham Labsaili
- Service de Chirurgie Cardio-Vasculaire, CHU IBN ROCHD, Casablanca, Maroc
| | - Said Makani
- Service de Chirurgie Cardio-Vasculaire, CHU IBN ROCHD, Casablanca, Maroc
| |
Collapse
|
21
|
Kalish J, Nguyen T, Hamburg N, Eberhardt R, Rybin D, Doros G, Farber A. Associated venous injury significantly complicates presentation, management, and outcomes of axillosubclavian arterial trauma. Int J Angiol 2013; 21:217-22. [PMID: 24293980 DOI: 10.1055/s-0032-1330969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Axillosubclavian vessel injury (ASVI) is associated with high morbidity and mortality. Most studies are single-center experiences of small numbers of patients with penetrating injury. We assessed 21st-century presentation and management of ASVI and focused on outcomes of combined arterial/venous injury. We reviewed the National Trauma Data Bank for patients with isolated arterial ASVI (group 1) and combined arterial/venous ASVI (group 2). Demographics, injury severity parameters, interventions, complications, and outcomes were compared. We identified 581 patients with ASVI (mean age 35.1; 88.1% male), with 466 isolated arterial injuries and 115 combined arterial/venous injuries. Group 2 had lower presenting systolic blood pressure and Glasgow Coma Scale, and had higher rates of operative repair (55.7 vs. 43.1%, p = 0.016) and higher mortality (33.9 vs. 13.9%, p < 0.001). There were no differences in amputation (5.2 vs. 2.4%, p = 0.121), compartment syndrome (2.6 vs. 1.9%, p = 0.713), and deep vein thrombosis (0.9 vs. 0.2%, p = 0.357). When separated by mechanism of injury, combined injuries from blunt trauma did increase amputation rates (27.8 vs. 4.2%, p = 0.002). Multivariate analysis revealed that combined arterial/venous injury significantly increased risk of death (odds ratio [OR], 2.99; confidence interval [CI], 1.73 to 5.17; p = 0.0001). Penetrating injury had higher odds of death than blunt injury (OR, 1.96; CI, 1.03 to 3.73; p = 0.041). ASVI is rare but extremely lethal. Concomitant venous and arterial injury is not associated with worse limb-related outcomes, except in blunt injuries and resultant amputations, but is associated with a threefold increase in mortality rates compared with isolated arterial injury.
Collapse
Affiliation(s)
- Jeffrey Kalish
- Division of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Massachusetts
| | | | | | | | | | | | | |
Collapse
|
22
|
Sinha S, Patterson BO, Ma J, Holt PJ, Thompson MM, Carrell T, Tai N, Loosemore TM. Systematic review and meta-analysis of open surgical and endovascular management of thoracic outlet vascular injuries. J Vasc Surg 2013; 57:547-567.e8. [DOI: 10.1016/j.jvs.2012.10.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/26/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
|
23
|
Abstract
We report the first case of a purely isolated axillary artery dissection because of focal blunt trauma to the axilla. A 42-year-old man presented to our outpatient orthopedic clinic 7 days after a fall during a hockey game whereby another player's skate blade struck the patient directly in the axilla without disrupting the skin. The patient denied having any symptoms of shoulder dislocation but experienced some pain and numbness, which subsided rapidly. Then he developed a cool hand with exertional claudication. Physical examination revealed absent radial and brachial pulses. Computed tomographic angiography demonstrated dissection of the distal axillary artery extending to the middle two-thirds of the brachial artery. Following urgent consultation with vascular surgery, the patient was treated operatively with reverse saphenous interpositional grafting and embolectomy. This case illustrates the need to have a heightened index of suspicion to all injuries to the axilla and the importance of performing careful soft tissue and neurovascular examinations in hockey players presenting with shoulder complaints, even when bony injury is not present.
Collapse
|
24
|
Gonçalves R, Saad Júnior R. [Surgical accesses to the major mediastinal vessels in thoracic trauma]. Rev Col Bras Cir 2012; 39:64-73. [PMID: 22481709 DOI: 10.1590/s0100-69912012000100013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 11/15/2010] [Indexed: 08/30/2023] Open
Abstract
Trauma is the most common cause of death in the economically active population and thoracic trauma is directly or indirectly responsible for one quarter of these deaths. Lesions to the large thoracic vessels are associated with immediate or early death in the hospital setting. Patients admitted alive can be classified as stable or unstable. The access route to be elected for management of these veins will depend on this status, as well as on the anatomical particularities of the patient, which may require combined incisions for adequate access. This article provides a review and discussion of lesions to these structures as well as access routes to them.
Collapse
|
25
|
Mollberg NM, Wise SR, De Hoyos AL, Lin FJ, Merlotti G, Massad MG. Chest computed tomography for penetrating thoracic trauma after normal screening chest roentgenogram. Ann Thorac Surg 2012; 93:1830-5. [PMID: 22560266 DOI: 10.1016/j.athoracsur.2012.02.095] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/16/2012] [Accepted: 02/20/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chest computed tomography (CCT) is a method of screening for intrathoracic injuries in hemodynamically stable patients with penetrating thoracic trauma. The objective of this study was to examine the changes in utilization of CCT over time and evaluate its contribution to guiding therapeutic intervention. METHODS A level 1 trauma center registry was queried between 2006 and 2011. Patients undergoing CCT in the emergency department after penetrating thoracic trauma as well as patients undergoing thoracic operations for penetrating thoracic trauma were identified. Patient demographics, operative indications, use of CCT, injuries, and hospital admissions were analyzed. RESULTS In all, 617 patients had CCTs performed, of whom 61.1% (371 of 617) had a normal screening plain chest radiograph (CXR). In 14.0% (51 of 371) of these cases, the CCT revealed findings not detected on screening CXR. The majority of these injuries were occult pneumothoraces or hemothoraces (84.3%; 43 of 51), of which 27 (62.8%) underwent tube thoracostomy. In only 0.5% (2 of 371), did the results of CCT alone lead to an operative indication: exploration for hemopericardium. The use of CCT in our patients significantly increased overall (28.8% to 71.4%) as well as after a normal screening CXR (23.3% to 74.6%) over the study period. CONCLUSIONS The use of CCT for penetrating thoracic trauma increased 3.5-fold during the study period with a concurrent increase in findings of uncertain clinical significance. Patients with a normal screening CXR should be triaged with 3-hour delayed CXR, serial physical examinations, and focused assessment with sonography for trauma; and CCT should only be used selectively as a diagnostic modality.
Collapse
Affiliation(s)
- Nathan M Mollberg
- Department of Surgery, Division of General Surgery, University of Illinois at Mount Sinai Hospital, and Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60608, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Mazzini FN, Vu T, Prichayudh S, Sciarretta JD, Chandler J, Lieberman H, Marini C, Asensio JA. Operative exposure and management of axillary vessel injuries. Eur J Trauma Emerg Surg 2011; 37:451. [PMID: 26815415 DOI: 10.1007/s00068-011-0134-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 06/19/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Axillary vessel injuries are uncommon and challenging injuries encountered by trauma surgeons. Proximity of this vessel to other adjacent veins including the axillary vein, brachial plexus and the osseous structures of the shoulder and upper arm account for a large number of associated injuries. MATERIALS AND METHODS Systematic review of the literature, with emphasis on the diagnosis, treatment and outcomes of these injuries, incorporating the authors' experience. CONCLUSIONS Although uncommon, axillary arterial injuries can result in significant morbidity, limb loss and mortality. Early diagnosis and timely repair of the artery leads to good outcomes.
Collapse
Affiliation(s)
- F N Mazzini
- Division of Trauma Surgery and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, 1800 NW 10 Avenue Suite T-247, Miami, FL, 33136-1018, USA
| | - T Vu
- Division of Trauma Surgery and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, 1800 NW 10 Avenue Suite T-247, Miami, FL, 33136-1018, USA
| | - S Prichayudh
- Division of Trauma Surgery and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, 1800 NW 10 Avenue Suite T-247, Miami, FL, 33136-1018, USA
| | - J D Sciarretta
- Division of Trauma Surgery and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, 1800 NW 10 Avenue Suite T-247, Miami, FL, 33136-1018, USA
| | - J Chandler
- Division of Trauma Surgery and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, 1800 NW 10 Avenue Suite T-247, Miami, FL, 33136-1018, USA
| | - H Lieberman
- Division of Trauma Surgery and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, 1800 NW 10 Avenue Suite T-247, Miami, FL, 33136-1018, USA
| | - C Marini
- Division of Trauma Surgery and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, 1800 NW 10 Avenue Suite T-247, Miami, FL, 33136-1018, USA
| | - J A Asensio
- Division of Trauma Surgery and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, 1800 NW 10 Avenue Suite T-247, Miami, FL, 33136-1018, USA.
| |
Collapse
|
27
|
Cvjetko I, Staresinic M, Hlevnjak D, Bakota B, Dovzak I. Axillary artery dissection after scapular fracture. Ann Vasc Surg 2011; 25:837.e5-7. [PMID: 21530158 DOI: 10.1016/j.avsg.2011.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 10/16/2010] [Accepted: 02/08/2011] [Indexed: 11/26/2022]
Abstract
Blunt shoulder trauma rarely causes damage to either arteries or nerves. Neurovascular structures are covered by muscles and protected by the surrounding bones deep in the axilla. We report a case of a 34-year-old male motorbike driver referred to us 5 hours after injury. Standard X-ray of the left shoulder revealed multipart fracture of the left scapula, and angiography showed that the first segment of the left axillary artery was dissected proximal to the minor pectoral muscle. Urgent diagnosis using imaging techniques and restoration of blood flow using open or endovascular repair are crucial for optimal outcome. Damage to the nerves predicts the final functional outcome regardless of prompt revascularization.
Collapse
Affiliation(s)
- Ivan Cvjetko
- Department of Vascular Surgery, University Hospital Merkur, Zagreb, Croatia.
| | | | | | | | | |
Collapse
|
28
|
Gill H, Jenkins W, Edu S, Bekker W, Nicol AJ, Navsaria PH. Civilian Penetrating Axillary Artery Injuries. World J Surg 2011; 35:962-6. [DOI: 10.1007/s00268-011-1008-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
29
|
Sobnach S, Nicol A, Nathire H, Edu S, Kahn D, Navsaria P. An Analysis of 50 Surgically Managed Penetrating Subclavian Artery Injuries. Eur J Vasc Endovasc Surg 2010; 39:155-9. [DOI: 10.1016/j.ejvs.2009.10.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 10/17/2009] [Indexed: 11/25/2022]
|
30
|
Penetrating thoracic great vessel injury: impact of admission hemodynamics and preoperative imaging. ACTA ACUST UNITED AC 2010; 68:834-7. [PMID: 20065882 DOI: 10.1097/ta.0b013e3181b250df] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The management of penetrating great vessel (PGV) injury is challenging. Patients in shock require rapid evaluation, whereas in stable patients, imaging studies may optimize the surgical approach. We reviewed our experience with PGV injury to determine the impact of admission blood pressure and accuracy of imaging studies, both angiography and computed tomographic angiography (CTA). METHODS Retrospective review of the trauma registry from 2001 to 2007 identifying patients with PGV injury. Demographics, admission systolic blood pressure, imaging studies, specific injuries, incision, methods of repair, hospital and intensive care length of stay, complications, and mortality were recorded. Shock was defined as systolic blood pressure <90 mm Hg. RESULTS Thirty-six consecutive patients were identified, average age was 28 (+/-10) years, of whom 20 (56%) presented in shock. Those in shock had more combined arterial-venous injuries (60% vs. 25%), concomitant thoracic injuries requiring resection (45% vs. 19%), and units of packed red blood cells (5.8 +/- 2 vs. 2.7 +/- 1.5), p < 0.01. For those in shock, the mean time to the operating room was 27 minutes +/- 9 minutes and 75% had sternotomy. Among stable patients, 56% had a periclavicular approach and 31% partial sternotomy. All 16 stable patients had imaging; angiography in 3 patients and CTA in 7 patients. In six patients who had both angiography and CTA, the results were concordant; therefore, CTA accurately diagnosed arterial injury in all 13 patients. Imaging changed the choice of incision in 4 (25%). Intensive care length of stay was significantly longer in the shock group 3.1 (+/-2.1) days versus 1.4 (+/-1.6) days (p = 0.01). There were 5 (14%) complications and no deaths. CONCLUSION Patients in shock require rapid evaluation. Sternotomy affords excellent exposure to all PGV injuries, and partial sternotomy is useful in stable patients. In stable patients, CTA can be valuable in defining the injury and may influence the surgical approach. Surgical results are surprisingly good, even in unstable patients and may be related to rapid transport and operation.
Collapse
|
31
|
Modern management of traumatic subclavian artery injuries: a single institution's experience in the evolution of endovascular repair. Am J Surg 2010; 199:28-34. [PMID: 19520356 DOI: 10.1016/j.amjsurg.2008.11.031] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 11/21/2008] [Accepted: 11/21/2008] [Indexed: 11/20/2022]
|
32
|
Vascular injuries after blunt chest trauma: diagnosis and management. Scand J Trauma Resusc Emerg Med 2009; 17:42. [PMID: 19751511 PMCID: PMC2749011 DOI: 10.1186/1757-7241-17-42] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 09/14/2009] [Indexed: 01/12/2023] Open
Abstract
Background Although relatively rare, blunt injury to thoracic great vessels is the second most common cause of trauma related death after head injury. Over the last twenty years, the paradigm for management of these devastating injuries has changed drastically. The goal of this review is to update the reader on current concepts of diagnosis and management of blunt thoracic vascular trauma. Methods A review of the medical literature was performed to obtain articles pertaining to both blunt injuries of the thoracic aorta and of the non-aortic great vessels in the chest. Articles were chosen based on authors' preference and clinical expertise. Discussion Blunt thoracic vascular injury remains highly lethal, with most victims dying prior to reaching a hospital. Those arriving in extremis require immediate intervention, which may include treatment of other associated life threatening injuries. More stable injuries can often be medically temporized in order to optimize definitive management. Endovascular techniques are being employed with increasing frequency and can often significantly simplify management in otherwise very complex patient scenarios.
Collapse
|
33
|
Prichayudh S, Verananvattna A, Sriussadaporn S, Sriussadaporn S, Kritayakirana K, Pak-art R, Capin A, Pereira B, Tsunoyama T, Pena D. Management of upper extremity vascular injury: outcome related to the Mangled Extremity Severity Score. World J Surg 2009; 33:857-63. [PMID: 19189175 DOI: 10.1007/s00268-008-9902-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Mangled Extremity Severity Score (MESS) is an objective criterion for amputation prediction after lower extremity injury as well as for amputation prediction after upper extremity injury. A MESS of >or=7 has been utilized as a cutoff point for amputation prediction. In this study, we examined the result of upper extremity vascular injurty (UEVI) management in terms of the amputation rate as related to the MESS. METHODS During January 2002 to July 2007, we reviewed patients with UEVIs at our institution. Data collections included demographic data, mechanism of injuries, injury severity score (ISS), ischemic time, MESS, pathology of UEVI, operative management, and amputation rate. Decisions to amputate the injured limbs at our institution were made individually by clinically assessing limb viability (i.e., color and capillary refill of skin; color, consistency, and contractility of muscles) regardless of the MESS. The outcome was analyzed in terms of the amputation rate related to the MESS. RESULTS There were 52 patients with UEVIs in this study: 25 (48%) suffered blunt injuries and 27 (52%) suffered penetrating injuries. The age ranged from 15 to 59 years (mean 28.7 years). The mean ischemia time was 10.07 h. The mean ISS was 17.52. There were 12 patients (23%) with subclavian artery injuries, 3 patients (5.76%) with axillary artery injuries, 18 patients (34.61%) with brachial artery injuries, and 19 patients (36.54%) with radial artery and/or ulnar artery injuries. Primary repairs were performed in 45 patients (86.54%), with ligations in 3 patients (5.77%). An endovascular stent-graft was used in one patient (1.92%). Primary amputations were performed in three patients (5.77%). Secondary amputations (amputation after primary operation) were done in 4 of 49 patients (secondary amputation rate 8.16%). All amputation patients suffered blunt injuries and had a MESS of >or=7 (range 7-11). The overall amputation rate in this study was 13.46% (7/52 patients). Multivariate analysis revealed that the only factor significantly associated with amputation was the MESS. There were no amputations in 33 patients who had a MESS of <7. We could avoid amputation in 12 of 19 patients who had a MESS>or=7. There were no mortalities among 52 UEVI patients. CONCLUSIONS MESS, an outcome score used to grade the severity of extremity injuries, correlates well with the risk of amputation. Nevertheless, a MESS of >or=7 does not always mandate amputation. On the other hand, the MESS is a better predictor for patients who do not require amputation when the score is <7. The decisions to amputate in patients should be made individually based on clinical signs and an intraoperative finding of irreversible limb ischemia.
Collapse
Affiliation(s)
- Supparerk Prichayudh
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Bolívar-Gómez T, García-Martínez M, Gallego-Ferreiroa C, Vidal-Rey J. Tratamiento endovascular de una lesión contusa de la arteria axilar. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)05008-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
35
|
Sodhi KS, Arora J, Khandelwal N. Post-Traumatic Occlusion of Subclavian Artery With Clavicle Fracture. J Emerg Med 2007; 33:419-20. [DOI: 10.1016/j.jemermed.2007.02.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 01/22/2007] [Accepted: 02/20/2007] [Indexed: 11/15/2022]
|
36
|
Imaging and Intervention of Large Arterial Trauma. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
37
|
Ersel M, Kiyan S, Aksay E, Eygi B, Calkavur T. Axillary artery dissection due to blunt shoulder trauma. Am J Emerg Med 2007; 25:242-3. [PMID: 17276837 DOI: 10.1016/j.ajem.2006.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Accepted: 11/02/2006] [Indexed: 11/17/2022] Open
Affiliation(s)
- Murat Ersel
- Department of Emergency Medicine, Ege University Hospital, Bornova IZMIR, Turkey.
| | | | | | | | | |
Collapse
|