Subclavian Artery Injury Research Articles

Santral Venöz Girişim Sırasında Oluşan İyatrojenik Subklaviyan Arter Yaralanmasına Hibrid Yaklaşım

Santral Venöz Girişim Sırasında Oluşan İyatrojenik Subklaviyan Arter Yaralanmasına Hibrid Yaklaşım

Overcoming challenges of endovascular treatment of complex subclavian and axillary artery injuries in hypotensive patients

Overcoming challenges of endovascular treatment of complex subclavian and axillary artery injuries in hypotensive patients

Emergency Bedside Sonographic Diagnosis of Subclavian Artery Pseudoaneurysm With Brachial Plexopathy After Clavicle Fracture

Clavicle fractures are common; however, complications are unusual. Two such complications, subclavian artery pseudoaneurysm and brachial plexopathy, are rare events that can cause significant morbidity and mortality. We report the case of a 53-year-old man who presented with shoulder swelling and right arm weakness for 1 week. Three weeks before, he had fallen and fractured his right clavicle. On presentation to our emergency department, his examination revealed a brachial plexopathy and a large supraclavicular mass. An emergency bedside triplex sonogram was performed to characterize the mass and revealed a swirling pattern within a fluid collection anterior to the subclavian artery, suggestive of a pseudoaneurysm. After computed tomography-angiography, the patient was taken to the operating room, where he underwent hematoma washout and subclavian artery stent-graft placement. This case illustrates how bedside point-of-care sonography can rapidly assist in the initial assessment of subclavian artery injury.

Subclavian artery injury following blunt trauma: A report of three cases

Subclavian artery injuries are rare in blunt chest trauma, constituting just 1–2 percent of all acute vascular injuries. The diagnosis of injury to the subclavian artery is challenging as a good percentage of patients with such vascular injuries have palpable distal pulses, no signs of any external local trauma and associated injuries often divert the attention of treating physicians. Subclavian artery injuries are the second most common injuries to occur to the aortic arch vessels. The mechanism of injury to these vessels varies from deceleration to traction on upper extremity and neck. Angiography is vital in diagnosis and surgical planning of these patients depends on the site and side of the vascular injuries. Early surgical treatment is an important part of management of these patients. Endovascular treatment is of value in a selected subgroup of subclavian artery injury patients. Reported mortality of subclavian artery injuries varies according to haemodynamic status of patient, time of presentation and other associated injuries. A high degree of suspicion is key to diagnosing these vascular injuries. Early appropriate surgical repair of vascular injury, in combination with aggressive treatment of associated injuries, is important for the optimal outcome of these cases. Here we report three cases of subclavian artery injury, which were successfully treated in Hamad General Hospital by vascular surgery and intensive care teams.

Transcutaneous aortic valve implantation using the axillary/subclavian access with patent left internal thoracic artery to left anterior descending artery: Feasibility and early clinical outcomes

Both retrograde femoral and subclavian artery catheterization techniques have been described as the most common methods for the implantation of the Medtronic CoreValve percutaneous aortic valve (Medtronic Inc, Minneapolis, Minn). The subclavian artery has been shown to be a safe and effective alternative access route in patients with unfavorable femoral access. Of the patients who are identified as candidates for subclavian artery access, a subset possess a patent left internal thoracic artery to left anterior descending artery. This patent left internal thoracic artery presents an additional anatomic and clinical variable that must be taken into consideration to ensure procedural safety and efficacy. We describe the Medtronic CoreValve percutaneous aortic valve implantation using the subclavian arterial approach in patients with a patent left internal thoracic artery and report our study's findings. The CoreValve percutaneous aortic valve is a self-expandable nitinol-based frame with a porcine pericardial valve. The subclavian access was created by a small infraclavicular surgical incision to expose the artery. Rapid ventricular pacing was used to reduce cardiac output to perform the balloon aortic valvuloplasty via a 12F sheath inserted into the subclavian artery. An 18F sheath was then inserted into the artery down into the ascending aorta and used for introduction of the delivery catheter and implantation of the percutaneous aortic valve. With the use of this method, 19 patients (76 ± 13 years) whose surgical risk was deemed excessive because of severe comorbidity and in whom transfemoral catheterization was considered unfeasible or at risk of severe complications have received implants. Subclavian artery or left internal thoracic artery injury did not occur in any patient. Two deaths occurred. One patient died of right coronary artery occlusion during the procedure, and one patient died 48 hours after the procedure as the result of a tamponade after the temporary pacemaker wire ablation. This initial experience suggests that subclavian transarterial aortic valve implantation in patients with a patent left internal thoracic artery to left anterior descending artery is feasible and safe with satisfactory short-term outcomes.

Traumatic subclavian arterial rupture: a case report and review of literature

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.

Evolving role of endovascular techniques for traumatic vascular injury

Endovascular management of blunt aortic injury has dramatically reduced the morbidity and mortality associated with this specific injury. There remains a paucity of evidence quantifying the beneficial effects associated with endovascular (ENDO) techniques for other vascular injury types and little information regarding the impact ENDO techniques have had on the management of traumatic vascular injuries over time. We performed a retrospective analysis of data from the National Trauma Data Bank over 2002 to 2006 and 2008 time periods (NTDB 7.2 and RDS 2008). Injured patients undergoing any arterial vascular repair procedure using ENDO or standard open techniques were determined using ICD-9-CM procedure codes. Abbreviated Injury codes were used to select patients who suffered subclavian, carotid, or thoracic aortic injury. Logistic regression was used to determine whether EARLY ENDO procedures (first 24 hours after injury) were independently associated with a lower risk of mortality. The percentage of ENDO procedures significantly increased over time irrespective of mechanism of injury. When aortic (thoracic), subclavian, and carotid arterial injuries were analyzed, a significant decrease in mortality over time was found. The percentage of ENDO procedures for all arterial injury subtypes significantly increased in the RECENT (2008) period. Seventy-five percentage of ENDO procedures occurred early (initial 24 hours) with 20% of those patients being hypotensive upon arrival (systolic blood pressure <90 mm Hg). For patients who had vascular procedures in the RECENT period, regression analysis revealed that early ENDO procedures were independently associated with a 35% reduction in mortality risk (odds ratio, 0.65; 95% confidence interval, 0.5-0.8) after controlling for major confounders including mechanism of injury and presence of hypotension on arrival. ENDO procedures for arterial injury have increased over time while mortality for arterial injury subtypes has significantly decreased. Early ENDO procedures are common and are independently associated with a lower risk of mortality. These results suggest outcomes after vascular injury may benefit from ENDO expertise and that ENDO techniques should be incorporated into the early treatment algorithm of trauma patients with vascular injury, particularly those that require difficult operative exposure.

A Case of Subclavian Artery Injury Due to Blunt Trauma Treated Successfully by Endovascular Repair

A Case of Subclavian Artery Injury Due to Blunt Trauma Treated Successfully by Endovascular Repair

Urgent endovascular treatment of iatrogenic subclavian artery rupture: report of three cases.

The increased use of central venous catheters in modern medical practice has brought a proportional increase in the number of cases of iatrogenic vascular injuries. Concerning the subclavian artery, the site of the lesion and the vessel size demand urgent and effective treatment in order to obtain a favorable prognosis. It has been common practice for a long time to consider this type of lesion as a surgical emergency. Nevertheless, emerging endovascular interventional procedures appear to offer an alternative that is effective and safe as well. We hereby report three cases of subclavian artery injury, in which repair was achieved by endovascular approach with the placement of a cover stent. Hypovolemic shock (demonstrated in two patients) as well as brachial plexus palsy due to pseudoaneurysm of the subclavian artery (presented in another patient) were successfully managed by percutaneous brachial (in two patients) or right femoral (in the patient with the pseudoaneurysm) approach and placement of balloon expandable covered stents (4-9 mm x 38 mm). No procedure-related complications were observed. Short-term follow-up results in two of the three patients were quite satisfactory concerning patency.

Covered stent use after subclavian artery and vein injuries in the setting of vascular Ehlers-Danlos

Vascular Ehlers-Danlos (VED) represents a rare disorder in which a defect in collagen synthesis renders vessels to be extremely fragile. We report the successful repair of a subclavian artery pseudoaneurysm via a hybrid technique employing delivery of a covered stent along with video-assisted thoracoscopic ligation of the internal mammary artery in a patient with VED.

Endovascular Repair of Iatrogenic Subclavian Artery Perforations Using Stent-Graft: Report of a Case

Purpose: To report a case of iatrogenic subclavian artery perforation treated with Vascular Stent-Graft.Case Report: A 54-year-old married male was admitted to Chung Shin Hospital with the chief complaint of severe sharp pain in his right clavicular region after a traffic accident on April 6, 2009. Fracture of the right clavicle was diagnosed after X-ray examination. The patient immediately underwent open reduction and internal fixation (ORIF) with a Kirschner wire with an uneventful postoperative course. The K-wire was removed 4 weeks later, on May 8, 2009. However, pain in the right clavicular area recurred and lasted for almost one month. A repeated X-ray was showed ”Non-union of the right clavicular fracture”. The patient underwent a ”redo” open reduction (ORIF) on June 2, 2009. During the operation, the patient sustained an accidental right subclavian artery injury resulting in active bleeding and pseudo-aneurysm formation there of; he was transferred to Chung Shan Medical University Hospital, and after CT angiography, he underwent endovascular repair of his right subclavian artery perforation.Results: The endovascular prosthesis (Fluency Plus Vascular Stent Graft 10 60 mm, Bard®) was successfully deployed at the site of the pseudoaneurysm via ipsilateral femoral artery access. No signs of endograft occlusion, migration, deformation, or fracrture have been observed during the follow-up period of eleven months.Conclusion: Endovascular repair of the subclavian artery injury may be an acceptable alternative to other more invasive modes of therapy. A sufficiently long follow-up, however, is needed to determine if the design of this endograft will resist compression in this vascular location.

Temporary Balloon Tamponade for Managing Subclavian Arterial Injury by Inadvertent Central Venous Catheter Placement

Purpose To evaluate the feasibility, efficacy, and safety of a temporary balloon tamponade technique for managing subclavian arterial injury secondary to inadvertent central venous catheter placement. Materials and methods Patients with subclavian arterial injury caused by inadvertent placement of a central venous catheter (size range 7-F to 7.5-F) who were treated only with temporary balloon tamponade between February 2002 and October 2009 were included. A temporary balloon tamponade technique was used to treat 13 patients (6 men and 7 women; mean age 56.7 years; age range 28–80 years). Technical success, total balloon inflation time, and complications were evaluated. Results Technical success was achieved with the temporary balloon tamponade technique in 13 cases (100%). Eight patients were treated with one balloon inflation, and five patients with two inflations (mean inflations 1.4). The mean total balloon inflation time was 14 minutes ± 13. There was no recurrent bleeding, hematoma, or pseudoaneurysm that required additional interventional procedures or surgical repair. A thrombus was identified in the subclavian arterial lumen after removal of the balloon catheter in one case; however, the thrombus was nonocclusive and asymptomatic. Conclusions Temporary balloon tamponade seems to be technically feasible and effective with a good safety profile in the management of subclavian arterial injury caused by inadvertent central venous catheter placement. Intraluminal thrombus can be an associated complication of the procedure.

Tratamiento endovascular de lesiones traumáticas de troncos supra aórticos

Endovascular treatment of traumatic supra aortic trunk lesions Introduction: Traumatic lesions of supra aortic trunks (SAT) have an elevated morbidity and mortality, and its treatment is technically challenging. Endovascular techniques offer an effective solution with a lower risk, making it an attractive alternative. Objectives: Retrospective review of all the patients with SAT lesions treated with endovascular techniques. Results: Between March 2000 to August 2009, 8 patients were treated, 6 men, mean age 33.6 years. Three patients suffered blunt and 5 a penetrating trauma. The injured vessels were subclavian artery in 5, brachiocephalic trunk in two and common carotid in one. Of the 5 patients with subclavian artery injury, three had associated brachial plexus injury. Six patients were treated with an endo- graft and one with coil-embolization. One patient suffered an early partial collapse of his endograft, requiring an additional bare metal stent to maintain patency. In this series there was neither neurological morbidity nor operative mortality. Follow-up is 24.3 months, and primary assisted patency is 100% at 21.9 months with two patients lost to follow-up. Conclusions: Endovascular treatment of SAT lesions is effective, showing low

Versatility of a Mini-Trapdoor Incision in Upper Mediastinal Exposure

Exposure of the upper mediastinum and thoracic outlet can pose major surgical challenges. We report our application of a previously described mini-trapdoor incision to a variety of surgical problems involving the upper mediastinum and thoracic outlet, including subclavian vein thrombosis, penetrating subclavian artery injury, debridement of subjacent chest wall infection, lymph node excision, and Pancoast tumor resection. This versatile approach provides excellent structural visualization while obviating clavicular resection or sternoclavicular joint disruption, or both.

Arterial Injury Complicating Subclavian Central Venous Catheter Insertion

n i a a g n c INADEQUATE PLACEMENT of a subclavian venous catheter in the subclavian artery is a well-known complication.1,2 Three cases of accidental arterial puncture occurred with the implantation of subclavian venous catheters, 2 of which involved the subclavian artery leading to percutaneous treatment; and the other involved the aortic arch, resulting in surgical management, are described.

A Case of Iatrogenic Subclavian Artery Injury Successfully Treated with Endovascular Procedures

We report a case of a life-threatening massive hemothorax caused by iatrogenic injury of the right subclavian artery. The patient was successfully treated with placement of a covered stent. During the procedure, occlusion balloon catheters rapidly controlled the massive bleeding.

Management of Inadvertent Iatrogenic Subclavian Artery Injury With an Extravascular Bio-Inert Sealant

Management of Inadvertent Iatrogenic Subclavian Artery Injury With an Extravascular Bio-Inert Sealant

An Analysis of 50 Surgically Managed Penetrating Subclavian Artery Injuries

Objectives: The surgical management and outcome of penetrating subclavian artery (SCA) injuries is presented in this article. Design: A retrospective chart review is used to detail the management and outcome of penetrating SCA injuries. Patients and methods: Patients with penetrating SCA injuries presenting to the Groote Schuur Hospital from January 1997 to December 2007 were reviewed. Demographic data, mechanism of injury, associated injuries, angiographic findings, surgical treatment, hospital stay, complications and mortality were noted. Results: Fifty patients with penetrating SCA injuries were identified from an operating trauma database. Stab and gunshot wounds accounted for 40 and 10 SCA injuries, respectively. The mean Revised Trauma Score (RTS) was 7.2. Angiography was obtained in 37 patients; false aneurysm (13) and total occlusion (nine) were the two most common findings. A median sternotomy was required in 25 (50%) patients and emergency room thoracotomy was performed in two patients (4%) for initial haemorrhage control. Primary repair of SCA injuries was possible in 52% of the patients. Three SCA injuries (6%) were ligated and one patient received an endovascular stent. Morbidity was restricted to associated brachial plexus injuries. The limb salvage rate was 100% and there were no deaths. Conclusion: Preoperative angiography was useful in planning an operative approach. Primary repair was possible in the majority of the patients and ligation of SCA injuries was life-saving in critically ill patients.

An Analysis of 50 Surgically Managed Penetrating Subclavian Artery Injuries

An Analysis of 50 Surgically Managed Penetrating Subclavian Artery Injuries

Experience and Technique for the Endovascular Management of Iatrogenic Subclavian Artery Injury

Experience and Technique for the Endovascular Management of Iatrogenic Subclavian Artery Injury