Long-Term Outcomes of Open and Endovascular Axillosubclavian Interventions After Traumatic Injury Reveal High Rates of Limb Dysfunction

Abstract

Arterial axillosubclavian injuries (ASIs) are currently managed with open repair (OR) and endovascular stenting (ES). The long-term prognosis of patients with these and associated brachial plexus injuries is poorly understood. We hypothesize that OR and ES for ASI have similar long-term patency rates and that brachial plexus injuries would confer high long-term morbidity. All patients at a level-1 trauma center who underwent procedures for ASI over a 12-year period (2010 to 2022) were identified. Long-term outcomes of patency rates, types of reintervention, rates of brachial plexus injury, and functional outcomes were then investigated. Thirty-three patients underwent operations for ASI. OR was performed in 72.7% (n=24) and ES in 27.3% (n=9). ES patency was 85.7% (n=6/7) and OR patency was 75% (n=12/16), at a median follow-up of 20 and 5.5months respectively. In subclavian artery injuries, ES patency was 100% (n=4/4) and OR patency was 50% (n=4/8) at a median follow-up of 24 and 12months respectively. Long-term patency rates were similar between OR and ES (P=1.0). Brachial plexus injuries occurred in 42.9% (n=12/28) of patients. Ninety percent (n=9/10) of patients with brachial plexus injuries who were followed postdischarge had persistent motor deficits at median follow-up of 12months, occurring at significantly higher rates in patients with brachial plexus injuries (90%) compared to those without brachial plexus injuries (14.3%) (P=0.0005). Multiyear follow-up demonstrates similar OR and ES patency rates for ASI. Subclavian ES patency was excellent (100%) and prosthetic subclavian bypass patency was poor (25%). brachial plexus injuries were common (42.9%) and devastating, with a significant portion of patients having persistent limb motor deficits (45.8%) on long-term follow-up. Algorithms to optimize brachial plexus injuries management for patients with ASI are high-yield, and likely to influence long-term outcomes more than the technique of initial revascularization.