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Jayakumar TKN, Vasudev V. A novel approach for the repair of left subclavian artery aneurysm. JTCVS Tech 2023; 22:147-149. [PMID: 38152224 PMCID: PMC10750874 DOI: 10.1016/j.xjtc.2023.09.012] [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: 06/14/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
| | - Veena Vasudev
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, India
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Emergency transcervical innominate artery clamping: Is it a real option? J Thorac Cardiovasc Surg 2016; 151:1425-6. [PMID: 26856474 DOI: 10.1016/j.jtcvs.2015.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/30/2015] [Indexed: 11/20/2022]
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3
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Defining Zone I of penetrating neck trauma: A surgical controversy in the light of clinical anatomy. J Trauma Acute Care Surg 2016; 80:670-3. [PMID: 26808025 DOI: 10.1097/ta.0000000000000978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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4
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Fragmentation injury to the innominate artery in a three-year-old child. Ann Thorac Surg 2014; 97:1788-90. [PMID: 24792269 DOI: 10.1016/j.athoracsur.2013.07.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/09/2013] [Accepted: 07/22/2013] [Indexed: 11/23/2022]
Abstract
The management of vascular trauma in pediatric patients presents numerous challenges, especially in an austere environment. We present the case of a 3-year-old girl who sustained multiple fragmentation injuries to the right chest and right upper extremity as a result of combat activity in Iraq. This resulted in an occult pseudoaneurysm of the innominate artery identified during exploration of her right chest for a persistent air leak from the right side of the chest. Computed tomography angiography delineated the injury, which was surgically repaired. This report demonstrates the type of challenging cases encountered in a combat zone and illustrates the need for a national database of such injuries in pediatric patients to better inform surgical decision making.
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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]
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Affiliation(s)
- Riyad Karmy-Jones
- Harborview Medical Center, University of Washington, Seattle, Washington, USA
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Gasparri MG, Lorelli DR, Kralovich KA, Patton JH. Physical examination plus chest radiography in penetrating periclavicular trauma: the appropriate trigger for angiography. THE JOURNAL OF TRAUMA 2000; 49:1029-33. [PMID: 11130484 DOI: 10.1097/00005373-200012000-00009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine the role of physical examination, chest radiography, and angiography in the management of periclavicular penetrating trauma. METHODS A retrospective review of the last 100 patients who suffered periclavicular penetrating trauma was performed. Patients with hard signs of vascular injury went either directly to the operating room or first to the angiography suite depending on their hemodynamic stability. All others underwent angiography and subsequent intervention if needed. The results were examined to determine the role of arteriography in the absence of hard signs of vascular injury. RESULTS Of the 100 patients in the study, there were 81 without hard signs of vascular injury. All underwent angiography, with 11 "occult" injuries discovered. Each of these patients exhibited some physical examination or chest radiographic finding that may have predicted the presence of vascular injury. Using clinical criteria, physical examination was found to have a sensitivity of 82%, a specificity of 91%, a positive predictive value of 60%, and a negative predictive value of 96%. When coupled with the chest radiographic findings, these numbers were 100%, 80%, 44%, and 100%, respectively. Using these criteria would have eliminated the need for angiography in 56 (69%) patients and would not have missed any injuries. CONCLUSIONS In patients with periclavicular penetrating trauma, a normal physical examination and chest radiographic excludes vascular injury. Proximity alone does not warrant angiography, although the test may be useful for therapeutic interventions or to plan operative approaches. A prospective study is essential to validate these findings.
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Affiliation(s)
- M G Gasparri
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Lin PH, Bush RL, Weiss VJ, Dodson TF, Chaikof EL, Lumsden AB. Subclavian artery disruption resulting from endovascular intervention: treatment options. J Vasc Surg 2000; 32:607-11. [PMID: 10957671 DOI: 10.1067/mva.2000.109334] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endovascular intervention is a commonly accepted form of treatment in patients with subclavian artery stenosis. Complications will undoubtedly occur as the utility of catheter-based intervention continues to rise. We report two cases of subclavian artery disruption as a result of endovascular intervention. One patient had contrast extravasation after the deployment of a balloon-expandable stent in a stenotic subclavian artery, and the arterial injury was successfully treated with balloon tamponade. A second patient had a large subclavian pseudoaneurysm 4 months after a balloon-expandable stent placement. Successful repair was achieved in this patient by means of arterial reconstruction with a prosthetic bypass graft. These cases illustrate different therapeutic methods of treating subclavian artery rupture due to endovascular intervention.
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Affiliation(s)
- P H Lin
- Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Madoff DC, Brathwaite CE, Manzione JV, Bilaniuk JW, Giron F, Char D, Choi J, Bilfinger TV. Coexistent rupture of the proximal right subclavian and internal mammary arteries after blunt chest trauma. THE JOURNAL OF TRAUMA 2000; 48:521-4. [PMID: 10744296 DOI: 10.1097/00005373-200003000-00026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D C Madoff
- Department of Radiology, State University of New York at Stony Brook, 11794-8460, USA
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10
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Gonzalez RP, Falimirski ME. The Role of Angiography in Periclavicular Penetrating Trauma. Am Surg 1999. [DOI: 10.1177/000313489906500803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Our objective was to evaluate whether physical examination in conjunction with chest X-ray can accurately diagnose the presence of significant vascular injury in penetrating periclavicular trauma. Results from a management protocol for penetrating periclavicular trauma were reviewed for the period January 1992 through December 1996 at an urban Level I trauma center. All patients requiring angiography for periclavicular penetrating trauma with trajectory of the injury falling between the lateral border of the manubrium and the anterior axillary line were entered into the management protocol. All patients underwent anterior-posterior chest radiography on arrival to the trauma center and 6 hours after admission. Tube thoracostomy was placed if clinically indicated on presentation or for X-ray findings. Clinical assessment was performed on all patients, with emphasis placed on the presence of “hard” signs for vascular injury. In addition to accepted hard signs for vascular injury, significant chest tube output (>1000 cc) and chest X-ray findings consistent with significant hemorrhage were also considered hard signs for vascular injury. Assuming hemodynamic stability, all patients with suspected subclavian/axillary arterial injury based on wound trajectory or clinical findings consistent with vascular injury underwent angiography. Forty-six patients were entered into the protocol with 30 left-sided injuries and 16 right sided injuries. The majority of injuries were secondary to gunshot wounds (31), with 14 stab wounds and 1 shotgun injury. Emergency room chest X-ray results revealed 32 negative chest X-rays, 7 pneumothoraces, 2 hemopneumothoraces, 2 hemothoraces, and 3 chest tubes placed before initial chest X-ray. A total of 7 injuries were diagnosed, with 1 missed injury, resulting in a sensitivity of 86 per cent for clinical assessment. The missed injury was a pseudoaneurysm of an axillary artery secondary to a self-inflicted shotgun wound. One mortality occurred in this series, which was a death in the operating room secondary to blood loss from an axillary artery injury. We conclude that clinical assessment can adequately diagnose the presence of surgically significant vascular injury in periclavicular penetrating injuries with trajectories lateral to the manubrium.
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Affiliation(s)
- Richard P. Gonzalez
- Departments of Surgery, Christ Hospital and Medical Center, Oak Lawn and University of Illinois Medical Center, Chicago, Illinois
| | - Mark E. Falimirski
- Departments of Surgery, Christ Hospital and Medical Center, Oak Lawn and University of Illinois Medical Center, Chicago, Illinois
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Sharma OP, Rawitscher RE. Blunt vena azygos trauma: report of a case and review of world literature. THE JOURNAL OF TRAUMA 1999; 46:192-5. [PMID: 9932707 DOI: 10.1097/00005373-199901000-00034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- O P Sharma
- Trauma Service, The Toledo Hospital, Ohio 43606, USA
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Feliciano DV. 50 years of trauma, burns, and surgical critical care at the Southwestern Surgical Congress. Am J Surg 1998; 175:99S-107S. [PMID: 9558058 DOI: 10.1016/s0002-9610(98)00066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- D V Feliciano
- Emory University School of Medicine, and Grady Memorial Hospital, Atlanta, Georgia 30303, USA
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Prétre R, Chilcott M, Mürith N, Panos A. Blunt injury to the supra-aortic arteries. Br J Surg 1997. [DOI: 10.1046/j.1365-2168.1997.02756.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- P M Rommens
- Department of Traumatology and Emergency Surgery, Hospitals of the Catholic University of Leuven, Belgium
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Abstract
BACKGROUND Innominate artery stab wounds are rarely encountered, and the optimal management of this injury is different from that of blunt innominate injury in that permanent bypass shunting should not be necessary. METHODS The records of 19 patients with stab wounds of the innominate artery who were treated by our department from January 1982 to June 1995 were reviewed. RESULTS Eighteen patients (95%) sustained zone 1 neck stabs, with a similar proportion having only a single stab wound. Seventeen (89%) of the 18 patients having chest roentgenograms had mediastinal widening. Thirteen patients (68%) were hemodynamically stable at admission; the remainder were unstable (26%) or moribund (5%). Fourteen patients (74%) underwent angiography, with no false-negative studies for arterial injury. Associated injuries to thoracic viscera occurred in 4 patients (21%). All injuries were repaired with either direct suture (18 of 19) or prosthetic interposition grafting (1 of 19). One patient required cardiopulmonary bypass to repair complex injuries. The overall mortality rate was 5% (1 of 19), and complications occurred in 2 patients (11%). CONCLUSIONS Innominate artery stab wounds can be managed successfully without permanent bypass shunting and with a low mortality rate.
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Affiliation(s)
- J O Fulton
- Department of Cardiothoracic Surgery, University of Cape Town, South Africa
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Banks E, Chun J, Weaver FA. Chronic innominate artery dissection after blunt thoracic trauma: case report. THE JOURNAL OF TRAUMA 1995; 38:975-8. [PMID: 7602651 DOI: 10.1097/00005373-199506000-00032] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Blunt innominate chest trauma is relatively rare, with only 70 cases being reported in the surgical literature since 1960. This report describes a 20-year-old male who sustained a blunt chest injury that resulted in an innominate artery dissection. The patient's clinical course and management are discussed, as well as a review of the surgical literature.
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Affiliation(s)
- E Banks
- Department of Surgery, Division of Vascular Surgery, University of Southern California School of Medicine, Los Angeles 90033-4612, USA
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Affiliation(s)
- C Cooper
- Shock Trauma Center, Maryland Institute for Emergency Medical Service Systems, Baltimore
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Abstract
Thoracic great vessel injury accounts for a significant amount of the acute mortality rate from trauma. Early recognition permits early repair, usually best accomplished by the simplest yet most effective technique. Use of prosthetic material is encouraged. Cardiopulmonary bypass, hypothermia, and shunts are rarely required.
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Affiliation(s)
- K L Mattox
- Department of Surgery, Baylor College of Medicine, Houston, Texas
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Abstract
Civilian vascular trauma is not uncommon. Prompt treatment with modern vascular surgical techniques produces good results.
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Affiliation(s)
- P F Blacklay
- St. Bartholomew's Hospital, West Smithfield, London, UK
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Sherani TM, Fitzpatrick GJ, Phelan DM, O'Brien D, Al Tarief H, Neligan MC. Ruptured azygos vein due to blunt chest trauma. Br J Surg 1986; 73:885. [PMID: 3790913 DOI: 10.1002/bjs.1800731109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
We report the case of a patient presenting with blunt chest and head injuries. Initial emergency department evaluation revealed a pulmonary contusion and suspected closed head injuries. Computed tomographic scan of the head was unremarkable. An angiogram performed to further investigate the nature of his head injuries revealed a disruption of the brachiocephalic artery. The lesion was surgically repaired in the operating room and the patient was moved to the intensive care unit, where he remained comatose and died from complications of his head and chest injuries on the seventh post-operative day. The pathophysiology and clinical manifestations of injuries to the brachiocephalic artery are discussed.
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Van Way CW, Moore EE, Millikan JS. Management of vascular trauma. Postgrad Med 1983. [DOI: 10.1080/00325481.1983.11697842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Solheim K. Closed subclavian artery injuries. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1981; 15:283-7. [PMID: 7347900 DOI: 10.3109/14017438109100588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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