Abstract
Subclavian artery injuries represent an uncommon complication of blunt chest trauma, this structure being protected by subclavius muscle, the clavicle, the first rib, and the deep cervical fascia as well as the costo-coracoid ligament, a clavi-coraco-axillary fascia portion. Subclavian artery injury appears early after trauma, and arterial rupture may cause life-treatening haemorrages, pseudo-aneurysm formation and compression of brachial plexus. These clinical eveniences must be carefully worked out by accurate physical examination of the upper limb: skin color, temperature, sensation as well as radial pulse and hand motility represent the key points of physical examination in this setting. The presence of large hematomas and pulsatile palpable mass in supraclavicular region should raise the suspicion of serious vascular injury. Since the first reports of endovascular treatment for traumatic vascular injuries in the 90’s, an increasing number of vascular lesions have been treated this way. We report a case of traumatic subclavian arterial rupture after blunt chest trauma due to a 4 meters fall, treated by endovascular stent grafting, providing a complete review of the past twenty years’ literature.
Highlights
Traumatic subclavian arterial rupture represents an uncommon complication of blunt chest trauma
We report a case of traumatic subclavian arterial rupture after blunt chest trauma and clavicular fracture due to a 4 meters fall, treated by endovascular stent grafting
Discussion and review of literature The association of subclavian arterial rupture and blunt thoracic trauma has been analyzed in many reports: in an article by Rulliat and coll. the incidence of subclavian arterial rupture among 1181 thoracic traumatic injuries was 0.4% [4]; a recent study by Shalhub and coll. reported a 47% incidence of subclavian arterial rupture above all the blunt thoracic outlet arterial injuries (BTOAI) [5]; clavicular fractures were cited as the cause of 50% of traumatic subclavian artery injuries in another article by Kendall and coll. [1]
Summary
Traumatic subclavian arterial rupture represents an uncommon complication of blunt chest trauma. We report a case of traumatic subclavian arterial rupture after blunt chest trauma and clavicular fracture due to a 4 meters fall, treated by endovascular stent grafting. Subclavian arterial rupture is an uncommon complication of blunt thoracic trauma, and must be carefully ruled out because of its poor prognosis; in 1983 Sturm and Cicero have devised five criteria that should lead the examining physician to confirm the suspicion of arterial injury with arch aortography These criteria include first rib fracture, diminished or absent radial pulses, palpable supraclavicular hematoma, chest roentgenogram demonstrating a widened mediastinum or hematoma over the area of the subclavian artery, and brachial plexus palsy [6]. Analyzing the past 24 years literature [Table 1], we found out 750 subclavian arterial lesions, reported in 12 different works (associated axillo-subclavian lesions where not included in our review) Among these series, 79 patients underwent endovascular repair (10.5%). Arterial injuries were caused by blunt trauma in 56 cases (7.5%), and endovascular repair was performed in 5 of these cases (8.9%)
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