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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.
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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
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2
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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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3
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Talebagha S, Virvilis D, Clair DG. Giant subclavian artery pseudoaneurysm. J Vasc Surg 2021; 75:324-325. [PMID: 34949384 DOI: 10.1016/j.jvs.2020.12.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Daniel G Clair
- Division of Vascular Surgery, Prisma Health, Columbia, SC
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4
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Kawatani Y, Mochizuki T, Hori T. Traumatic brachial artery injury successfully treated with a stent-graft: A case report. Asian Cardiovasc Thorac Ann 2021; 30:586-588. [PMID: 34034504 DOI: 10.1177/02184923211019850] [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: 11/16/2022]
Abstract
There are few reports on brachial artery injury treated with stent-grafts. A 69-year-old man presented with a crush injury to the left upper arm. Enhanced computed tomography revealed left humerus fracture and disruption of the blood flow of the brachial artery along with paresis of the forearm. Following external fixation of the fracture, we performed endovascular therapy for brachial artery injury. Using real-time ultrasound imaging guidance, the injured lesion was crossed by the wire, and Viabahn endoprosthesis was placed in the left brachial artery. Hemostasis was achieved, and blood flow to the forearm was restored. Subsequently, the paresis improved.
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Affiliation(s)
- Yohei Kawatani
- Department of Cardiovascular Surgery, Kamagaya General Hospital, Kamagaha-Shi, Japan
| | - Takeshi Mochizuki
- Department of Orthopedic Surgery, Kamagaya General Hospital, Kamagaha-Shi, Japan
| | - Takaki Hori
- Department of Cardiovascular Surgery, Kamagaya General Hospital, Kamagaha-Shi, Japan
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5
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Lyons MM, Holzmeister AM, Cappello T. Nonoperative Management of Subclavian Artery Thrombosis in Pediatric Clavicle Fractures: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00018. [PMID: 33835993 DOI: 10.2106/jbjs.cc.20.00815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 12-year-old patient presented after a fall onto her upper extremity. She was found to have a mildly displaced clavicle fracture with a subclavian artery thrombosis. Given the reconstitution of flow distal to the thrombosis, the patient was treated nonoperatively in consultation with vascular surgery with anticoagulation and a sling for immobilization. CONCLUSION This case highlights the importance of a thorough neurovascular examination even in a mildly displaced fracture. Nonoperatively managed thromboses may be treated successfully without orthopaedic fixation or vascular intervention, although the natural history of this injury is likely not fully understood.
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6
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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.
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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
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7
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Tadayon N, Yavari N, Zarrintan S, Hosseini SM, Kalantar-Motamedi SMR. Management of traumatic subclavian artery injuries in a high-volume vascular surgery center in Iran. J Cardiovasc Thorac Res 2020; 12:145-149. [PMID: 32626556 PMCID: PMC7321003 DOI: 10.34172/jcvtr.2020.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Subclavian artery injury is an uncommon vascular trauma with potential morbidity and mortality. Management of subclavian artery trauma requires open and endovascular techniques and timely and efficacious decision is mandatory. We retrospectively reviewed traumatic subclavian artery injuries in a high-volume vascular surgery center in Iran.
Methods: In a retrospective study, we assessed subclavian artery injuries during 6 years in ShohadaTajrish Medical Center. Background characteristics, type of incision, type of operation and outcome of patients were evaluated.
Results: A total of 14 patients had subclavian artery injury (mean age 29.9 ± 13.4 years, 92.9% male). Trauma was in left and right sides in eight (57.1%) and six patients (42.9%) respectively. Arteriorrhaphy, interposition and ligation of injured artery was done in 7 (50.0%), 3 (21.4%) and 4 (28.6%) patients respectively. Associated nerve injury was present in six patients (42.9%). Endovascular proximal control was obtained in six patients (42.9%) prior to vascular exposure. Time of patient referral did not have significant association with shock or type of operation (P > 0.05).
Conclusion: Although traumatic subclavian artery injuries are rare, its vascular exposures and reconstructions are of potential clinical concern. Endovascular interventions can facilitate proximal control. In addition, endovascular repair by covered stent is an alternative to open surgery.
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Affiliation(s)
- Niki Tadayon
- Division of Vascular & Endovascular Surgery, Department of General & Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Iranian Society of Vascular Surgery, Tehran, Iran
| | - Negin Yavari
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Zarrintan
- Division of Vascular & Endovascular Surgery, Department of General & Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Iranian Society of Vascular Surgery, Tehran, Iran.,Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Masoud Hosseini
- Division of Vascular & Endovascular Surgery, Department of General & Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Iranian Society of Vascular Surgery, Tehran, Iran
| | - Seyed Moahammad Reza Kalantar-Motamedi
- Division of Vascular & Endovascular Surgery, Department of General & Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Iranian Society of Vascular Surgery, Tehran, Iran
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8
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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.
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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
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9
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Makida K, Iwase T, Tanaka K, Kobayashi M. Hybrid surgery for a pseudoaneurysm caused by a clavicle fracture. J Orthop Sci 2019; 24:1130-1132. [PMID: 28554715 DOI: 10.1016/j.jos.2017.05.003] [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: 12/16/2016] [Revised: 04/26/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Kazuya Makida
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan.
| | - Toshiki Iwase
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Kuniyoshi Tanaka
- Department of Cardiovascular Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
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10
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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.
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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
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11
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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.
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12
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Kluemper C, Koestner T, Cowart J, Higgins M. Intercostal Entrapment of Clavicle Fracture Causing a Pulseless, Flaccid Upper Extremity. J Hand Surg Am 2018; 43:1143.e1-1143.e4. [PMID: 29678429 DOI: 10.1016/j.jhsa.2018.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 02/04/2018] [Accepted: 03/13/2018] [Indexed: 02/02/2023]
Abstract
Limb-threatening vascular compromise from an isolated closed clavicle fracture is exceedingly rare. We report a case of a posteriorly angulated, closed clavicle fracture segment causing right upper-extremity ischemia, numbness, and paresis caused by entrapment of the clavicle between the first and second ribs.
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Affiliation(s)
- Chase Kluemper
- Department of Orthopedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN.
| | - Tyler Koestner
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Justin Cowart
- Department of Orthopedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Matt Higgins
- Department of Orthopedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
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13
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Buchanan DAS, Owen D, Angliss R, McClure DN. Acute subclavian artery occlusion with associated clavicle fracture managed with bypass graft alone. BMJ Case Rep 2018; 2018:bcr-2018-224719. [PMID: 29954765 DOI: 10.1136/bcr-2018-224719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Subclavian artery injury is a rare consequence of clavicle fracture. It most often results from penetrating trauma but can result from blunt trauma with adjacent bone fragments causing rupture, pseudoaneurysm, dissection or thrombosis of the artery. If flow through the subclavian artery is compromised there is a risk of ipsilateral upper limb ischaemia. Life-threatening haemorrhage may result in cases of laceration, and cerebral infarction may result from dissection. Vascular injury in association with clavicle fracture is typically regarded as an indication for internal fixation of the fracture. We present a case of subclavian artery thrombosis in association with a comminuted midshaft clavicle fracture causing limb ischaemia managed by carotid to brachial artery bypass without internal fracture fixation. The fracture united at 4 weeks and there was no sustained vascular or neurological impairment at follow-up. We advocate urgent vascular intervention in subclavian artery injury. There is little discussion in the literature regarding non-operative management of clavicle fractures with subclavian artery injury. We suggest that select clavicle fractures with subclavian artery injury can be safely managed non-operatively.
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Affiliation(s)
- Dougal A S Buchanan
- Department of Vascular and Endovascular Surgery, Barwon Health, Geelong, Victoria, Australia
| | - David Owen
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Richard Angliss
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Victoria, Australia
| | - David N McClure
- Department of Vascular and Endovascular Surgery, Barwon Health, Geelong, Victoria, Australia
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14
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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.
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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
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15
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Sladojevic M, Markovic M, Ilic N, Pejkic S, Banzic I, Djoric P, Koncar I, Tomic I, Davidovic L. Open Treatment of Blunt Injuries of Supra-Aortic Branches: Case Series. Ann Vasc Surg 2015; 31:205.e5-205.e10. [PMID: 26647209 DOI: 10.1016/j.avsg.2015.07.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/22/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Blunt injuries of the supra-aortic branches are rare entity, and majority of patients die before arrival at the hospital. Those who arrive alive require complex and fast procedure that requires sternotomy. We report 3 successfully managed cases. CASE REPORTS We report 3 patients with injury of supra-aortic branches. One was treated urgently due to longitudinal rupture on the posterior wall of innominate artery after car accident, and another 2 had chronic false aneurysm located at the very orifice of the right subclavian and left common carotid artery. In first and second patient bypass grafting with a hand-made, Y-shaped, 8-mm Dacron graft from the ascending aorta to the right common carotid and proximal right subclavian artery were performed, whereas in last 1 bypass grafting from the ascending aorta to the cervical part of the left common carotid artery was performed. In our facility, there were no possibilities for any endovascular treatment. CONCLUSIONS When endovascular technology is not available, open surgical repair of blunt injuries of supra-aortic vessels can be performed without complications. No matter to that, endovascular and hybrid procedures should be considered whenever possible.
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Affiliation(s)
- Milos Sladojevic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Miroslav Markovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Ilic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sinisa Pejkic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Banzic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Predrag Djoric
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Tomic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Nishimura K, Hamasaki T, Yamamoto S, Kawai T, Sugiura K. Endovascular Treatment of Left Subclavian Artery Pseudoaneurysm after Clavicle Fracture in an Elderly Adult with a 40-Year History of Behçet's Disease. Ann Vasc Dis 2015; 8:328-30. [PMID: 26730261 PMCID: PMC4691510 DOI: 10.3400/avd.cr.15-00082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/30/2015] [Indexed: 11/13/2022] Open
Abstract
Behçet's disease (BD) is a rare chronic systemic vasculitis of unknown etiology that presents in young adults. We report a very rare case of a left subclavian artery pseudoaneurysm identified after a left clavicle fracture in a 70-year-old man with a 40-year history of intestinal BD. The patient received fixation by banding to treat a fracture after falling from a bed about 5 months previously, and he was referred to our hospital due to the finding of a left subclavian pulsatile mass. As enhanced computed tomography showed a left subclavian artery pseudoaneurysm, it was repaired using an endovascular stent graft.
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Affiliation(s)
- Kengo Nishimura
- Department of Surgery, Tottori Prefectural Kosei Hospital, Kurayoshi, Tottori, Japan
| | - Takafumi Hamasaki
- Department of Surgery, Tottori Prefectural Kosei Hospital, Kurayoshi, Tottori, Japan
| | - Shuichi Yamamoto
- Department of Radiology, Tottori Prefectural Kosei Hospital, Kurayoshi, Tottori, Japan
| | - Tsuyoshi Kawai
- Department of Radiology, Tottori Prefectural Kosei Hospital, Kurayoshi, Tottori, Japan
| | - Kimihiko Sugiura
- Department of Radiology, Tottori Prefectural Kosei Hospital, Kurayoshi, Tottori, Japan
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17
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Nakada TA, Idoguchi K, Fukuma H, Ono H, Nakao S, Matsuoka T. Case Report: Urgent endovascular treatment of subclavian artery injury after blunt trauma. F1000Res 2014; 3:310. [PMID: 25717371 PMCID: PMC4329670 DOI: 10.12688/f1000research.5963.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 11/20/2022] Open
Abstract
Subclavian arterial injury is rare and potentially life-threatening, particularly when it leads to arterial occlusion, causing limb ischemia, retrograde thromboembolization and cerebral infarction within hours after injury. Here we report a blunt trauma case with subclavian arterial injury, upper extremity ischemia, and the need for urgent treatment to salvage the limb and prevent cerebral infarction. A 41-year-old man had a left, open, mid-shaft clavicle fracture and left subclavian artery injury accompanied by a weak pulse in the left radial artery, decreased blood pressure of the left arm compared to the right, and left hand numbness. Urgent debridement and irrigation of the open clavicle fracture was followed by angiography for the subclavian artery injury. The left distal subclavian artery had a segmental dissection with a thrombus. Urgent endovascular treatment using a self-expanding nitinol stent successfully restored the blood flow and blood pressure to the left upper extremity. Endovascular treatment is a viable option for cases of subclavian artery injury where there is a risk of extremity ischemia and cerebral infarction.
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Affiliation(s)
- Taka-Aki Nakada
- Senshu Trauma and Critical Care Center, Osaka, 598-8577, Japan
| | - Koji Idoguchi
- Senshu Trauma and Critical Care Center, Osaka, 598-8577, Japan
| | - Hiroshi Fukuma
- Senshu Trauma and Critical Care Center, Osaka, 598-8577, Japan
| | - Hidefumi Ono
- Senshu Trauma and Critical Care Center, Osaka, 598-8577, Japan
| | - Shota Nakao
- Senshu Trauma and Critical Care Center, Osaka, 598-8577, Japan
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Ribeiro Ribeiro AL, Brasil da Silva W, Alves-Junior SDM, de Jesus Viana Pinheiro J. Giant life-threatening external carotid artery pseudoaneurysm caused by a mandibular condylar fracture. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:e95-e100. [PMID: 25442245 DOI: 10.1016/j.oooo.2014.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 08/27/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Vascular lesions are rare complications associated to mandibular condylar fractures. This paper aims to describe a case of a giant pseudoaneurysm involving the external carotid artery (ECA) caused by a condylar fracture. CASE REPORT A 33-year-old man was the victim of traffic accident and presented with a panfacial fracture, including a bilateral condylar fracture. The condylar fracture was treated by closed reduction, and 4 weeks after treatment, the patient developed facial edema, which suggested postoperative infection. An attempt at draining it resulted in intensive bleeding. A computed tomographic angiography showed a huge pseudoaneurysm originating from the ECA. The patient was treated with surgery with ligation of the ECA and drainage of the pseudoaneurysm. CONCLUSION Vascular complications associated with condylar fractures are rare, but surgeons should be aware of this type of complication, especially because of the high risk of serious damage, including death. The use of computed tomographic angiography is very helpful in the diagnosis of vascular lesions and also guides treatment.
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Affiliation(s)
- André Luis Ribeiro Ribeiro
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University Center of Pará-CESUPA, Belém, Brazil.
| | - Walessa Brasil da Silva
- Department of Oral Pathology, School of Dentistry, Federal University of Pará-UFPA, Belém, Brazil
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Oliveira N, Alves G, Rodrigues H, Gonçalves FB, Martins J, Morais JA, Ferreira ME, Castro JA, Capitão LM. Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries. ANGIOLOGIA E CIRURGIA VASCULAR 2014. [DOI: 10.1016/j.ancv.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Life-threatening expansive sublingual hematoma: a stab wound with lingual artery injury. J Craniofac Surg 2014; 25:e61-5. [PMID: 24406604 DOI: 10.1097/scs.0b013e3182a4c6b9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Vascular injuries are a constant risk in facial trauma, although bone and soft tissues of the face have provided some protection to the larger blood vessels. However, penetrating injuries usually do not have this type of protection and can damage significant vascular arteries. This article presents a case of a stab wound, which led to airway obstruction arising to a large sublingual hematoma due to lingual artery injury. A healthy 44-year-old man was stabbed in the submandibular region and admitted with an airway obstruction. He was subjected to an emergency tracheotomy and evolved with progressive sublingual edema. Computed tomography (CT) angiography showed a left lingual artery injury with the formation of an expansive hematoma. The CT angiography findings helped to identify the cause of the hematoma and guided the surgery to drain the hematoma after ligation of the lingual artery. The treatment was safely performed as planned and evolved uneventfully. The patient recovered fast and well and presented normal functions 6 months after the treatment. This surgical technique is an effective method for treating such injuries because it can be safely performed when guided by CT angiography. The authors argue that the demand for vascular lesions should be routine in patients who have facial trauma.
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