Subclavian Artery Injury Research Articles

Use of VIABAHN Stent Graft for Subclavian Artery Injury due to Inadvertent Catheter Placement

Use of VIABAHN Stent Graft for Subclavian Artery Injury due to Inadvertent Catheter Placement

Comparison of traditional vascular reconstruction with covered stent in the treatment of subclavian artery injury

PurposeTo explore the significance of traditional vascular reconstruction and covered stent for limb salvage after subclavian artery injury. MethodsPatients with subclavian artery injury admitted to Beijing Jishuitan Hospital from January 2010 to December 2018 were retrospectively analyzed. All the injuries have been confirmed by intraoperative exploration, computed tomography angiography or digital subtraction angiography. Complete or partial amputation injuries were excluded. Mild artery defect or partial intimal damage was treated by interventional implantation, while other patients received open surgeries, including direct suture of small defect less than 2 cm and transplantation with autologous vein or artificial blood when the defect was more than 2 cm. Patients were divided into open surgery group and stent implantation group based on the treatment they received. Patients were followed up at 2 weeks (first stage) and 6 months (second stage) after operation to investigate limb salvage. Student's t-test was used to compare the general data between two groups and Chi-square test to analyze the rate of limb salvage. ResultsAltogether 50 cases of subclavian artery injury were treated, including 36 cases of open surgery and 14 cases of stent implantation. Combination of nerve injury was observed in 27 cases (75.0%) in open surgery group and 12 cases (85.7%) in stent implantation group. Amputation developed in 3 cases with open surgery and 1 case with stent implantation. Consequently the rate of successful limb salvage was respectively 91.7% (33/36) and 92.9% (13/14), revealing no significant difference (p > 0.05). ConclusionRapid reconstruction of blood circulation is crucial following subclavian artery injury, no matter what kinds of treatment strategies have been adopted. Interventional stent implantation can achieve a good effect for limb salvage.

Management of traumatic subclavian artery injuries in a high-volume vascular surgery center in Iran.

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.

Evaluation of Subclavian, Thoracic Aorta, and Innominate Artery Injuries in Blunt Trauma Mechanisms: A Systematic Review of Case Reports and Case Series

Background: Blunt thoracic arterial injuries are one of the uncommon presentations in trauma clinical experiences. Most reports are case reports and case series and no significantly consolidated data is available. This is an attempt to organize case reports and case series. Methodology: Pubmed and Google scholar were utilized to find case reports and case series on each artery separately with data search limited to publications between 2000 and 2019. The retrieved data are extracted using tables with specific components for data interpretation and the data was finally entered and analyzed using SPSS version 23. Results: The mean ages were between 35.9 and 44.3 years with male proportions were 76.5% to 89.7% across the three groups of patients. Motor vehicle related injuries contributed between 49.9% and 81.2%in the three groups. Blood pressure/pulse deficit was recorded in 34.8% and 20,7% of patients with Subclavian and Innominate artery injuries respectively with chest pain and hemodynamic instability found in 23.5% and 20.5% of Aortic injury patients respectively. Clavicular fracture was evident in 42.2% of Subclavian artery injury patients. Computed tomography was performed in 21.7%, 47.1%, 27.6% of patients with Subclavian artery, Aortic and Innominate artery injuries respectively. Endovascular procedure was performed in 44.1% of patients with Subclavian artery injury. Conclusion: Injury to Subclavian artery is relatively common among older population. Blood pressure or pulse discrepancy could point to either Subclavian or Innominate artery injury. Computed Tomography can be efficiently used in all the Arteries but there is poor experience regarding its use in Innominate artery injuries for this reason lower threshold for Conventional angiography should be preferred. Endovascular procedure can be considered in all patients but has to be individualized based on patient and facility factors. Keywords: Aortic rupture; clavicular fracture; traumatic pseudoaneurysm; endovascular repair; cerebrovascular accident

Penetrating Subclavian Artery Injuries: Recent Challenges with Variable Solutions

Penetrating Subclavian Artery Injuries: Recent Challenges with Variable Solutions

Impalement at Zone I of Neck Causing Traumatic Subclavian Arterial Compression Injury

Impalement at Zone I of Neck Causing Traumatic Subclavian Arterial Compression Injury

Clavicle Fracture with Injury of Subclavian Artery and Brachial Plexus: Case Report

Clavicle fractures are extremely common, accounting for up to 2.6-12% of all fractures [1-4] and 44-66% of all fractures about the shoulder.

Endovascular Management following Unintentional Subclavian Artery Injury during Central Venous Catheter Placement

Background
 Traumatic injury to the subclavian artery during central venous catheter (CVC) placement is rare but can be catastrophic. Standard open surgical treatment is challenging and associated with significant complications. Presented is a case of endovascular treatment of these injuries and associated complications.
 Methods and Results
 This is a description of the endovascular repair of a subclavian artery injury during CVC placement at Örebro University Hospital.
 Conclusion
 This case report suggests that endovascular repair of subclavian artery injuries a less invasive and may decrease the morbidity and mortality associated with open surgical repair.

Redefining the morphometry of subclavian vessels for clavicle fracture treatments.

Clavicle fractures are common injuries in adults and children. Although neurovascular damage is rarely seen, acute subclavian artery pseudoaneurysms and injuries to subclavian vessels were reported for closed fractures of the clavicle. The aim of this study was to identify the morphological details of the subclavian vessels and their relation to the sternoclavicular joint and body of the clavicle. 127 patients (66 females and 61 males) were evaluated using reconstructed three-dimensional computed tomographic angiographies. The point at which the subclavian artery crossed posterior to the clavicle was detected as a landmark. The medio-lateral distance between the sternal end of the clavicle, landmark, antero-posterior distance between the clavicle and the subclavian artery, diameter of the artery and vein, angle between the subclavian artery and vein, distance of the subclavian vein to the subclavian artery and the clavicle at the landmark were measured. Measurements were compared according to gender and right and left sides, and age correlation was determined. Morphometric relationship between the subclavian vessels and clavicle presented differences between genders. We measured the antero-posterior distance between the subclavian artery and the clavicle to be less than 1cm (0.91cm). The subclavian artery travelled longer distances in men than women to reach the point that it crossed the clavicle. Our results demonstrated that the subclavian artery does not pass from the inferior margin of the clavicle, thus, superior plate osteosynthesis does not have any risk to injury against the subclavian vessels during the management of the clavicle fractures.

Is First Rib Fracture a Culprit or a Sign of Injury Severity? It Is Both.

First rib fractures (first RFX) have been correlated with increased morbidity and mortality. Whether this is due to the fracture of the rib itself or due to an increased number of associated injuries remains debatable. Retrospective cohort study. Level 1 trauma center. One thousand eighty-nine patients with rib fractures divided into 3 groups: group A (n = 44) with isolated first RFX, group B (n = 116) with first RFX combined with other rib fractures, and group C (n = 929) with rib fractures without first RFX. None. Age, sex, Injury Severity Score, mortality, number of ribs fractured (RFX), incidences of flail chest, multiple coinjuries, hospital and intensive care unit lengths of stay, and duration of mechanical ventilation. Group A, when compared with group B, had significantly lower Injury Severity Score, RFX, rates of flail chest, pulmonary coinjuries, and shorter hospital length of stay and intensive care unit length of stay. Group A compared with group C had significantly lower age, RFX, rates of flail chest, and hemopneumothorax. In group B, all outcome measurements were significantly higher than those in group C. Incidence of subclavian artery, brachial plexus, and first thoracic vertebra injuries was significantly higher in group A. Frequency of traumatic brain and orthopaedic coinjuries was comparable in both groups with first RFX. Isolated first RFX alone are associated with higher incidence of injuries to subclavian structures and the first thoracic vertebrae. When they are combined with fractures of other ribs, the overall severity of trauma expands significantly. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Use of Fogarty Catheter in the Surgical Treatment of Traumatic Pseudoaneurysm of the Subclavian Artery: a Simple and Minimal Invasive Approach

Subclavian artery injuries are rare and associated with blunt injuries and can result in puncture and pseudoaneurysm formation requiring urgent management. Different treatment modalities are there, but open surgical repair remains the best choice. A 35-year-old male patient presented to us with a huge swelling over the right side of the anterior chest wall for three months following fracture of the clavicle six months back. On evaluation, it was found to be right subclavian artery pseudoaneurysm of size 14 cm × 14.8 cm × 11.2 cm. Surgery was done with arteriotomy on the right brachial artery with passage of the Fogarty catheter past the pseudoaneurysm and balloon inflated to control the proximal part of the artery and supraclavicular incision given to excise the pseudoaneurysm as well as repair the artery with an autologous venous graft. Surgical repair of the pseudoaneurysm of the subclavian artery with the use of the Fogarty catheter to control the proximal part of artery is a simple, innovative and minimal invasive approach alternative to major surgical procedure, thereby reducing the morbidity and other inadvertent complications.

Endovascular Treatment of a Gunshot Injury of the Subclavian Artery

Objectives: We present a case of a patient with a right subclavian artery injury due to a gunshot, treated by endovascular approach in our clinic in Kielce, Poland. Case report: A 35-year-old male, presented with a penetrating injury of the right supraclavicular region due to a shotgun slug. The patient was hemodynamically unstable. Both chest radiograph and CTA (Computed Tomography Angiography) imaging presented an injury of the right subclavian artery, multisegmental rib fractures of ribs I-III and a hemo-pneumothorax. Endovascular repair of the subclavian artery was performed, followed by insertion of a Redon wound drain and right-sided pleural drain. The patient was then transported to the thoracic surgery unit, where further therapy, including a removal of the bullet from the thoracic wall, was performed. Upon a 4 months follow-up visit, the patient was in a good condition and a CTA scan performed at this time confirmed the patency of the right subclavian artery. Conclusions: Endovascular repair presents a viable alternative option for treating subclavian artery injuries, even in hemodynamically unstable patients.

Endovascular repair of traumatic subclavian artery pseudoaneurysm: a case report and review of the literature

Traumatic subclavian artery injury resulting in pseudoaneurysm formation is relatively uncommon. With the increasing percutaneous arterial interventions utilization worldwide, the number of pseudoaneurysm formation has increased owing to iatrogenic arterial injury. After trauma, injury of subclavian artery early appears, and many complications such as life-threatening bleeding, the creation of pseudoaneurysm, and brachial plexus compression may be caused by the arterial rupture. The presence of large hematoma and pulsatile palpable mass in the supraclavicular region should raise the suspicion of severe vascular injury. Surgical thoracotomy and direct arterial repair traditionally treated subclavian artery pseudoaneurysms. However, significant morbidity is usually associated with surgical repair. In recent years, endovascular stent grafting has become an attractive intervention with less invasiveness and morbidity for these injuries. We have a case report of pseudoaneurysm following traumatic right subclavian artery owing to penetrating neck trauma caused by bullet injury, which was treated successfully by endovascular stent grafting, providing a complete review of the literature.

Contemporary management of subclavian and axillary artery injuries—A Western Trauma Association multicenter review

Subclavian and axillary artery injuries are uncommon. In addition to many open vascular repairs, endovascular techniques are used for definitive repair or vascular control of these anatomically challenging injuries. The aim of this study was to determine the relative roles of endovascular and open techniques in the management of subclavian and axillary artery injuries comparing hospital outcomes, and long-term limb viability. A multicenter, retrospective review of patients with subclavian or axillary artery injuries from January 1, 2004, to December 31, 2014, was completed at 11 participating Western Trauma Association institutions. Statistical analysis included χ, t-tests, and Cochran-Armitage trend tests. A p value less than 0.05 was significant. Two hundred twenty-three patients were included; mean age was 36 years, 84% were men. An increase in computed tomography angiography and decrease in conventional angiography was observed over time (p = 0.018). There were 120 subclavian and 119 axillary artery injuries. Procedure type was associated with injury grade (p < 0.001). Open operations were performed in 135 (61%) patients, including 93% of greater than 50% circumference lacerations and 83% of vessel transections. Endovascular repairs were performed in 38 (17%) patients; most frequently for pseudoaneurysms. Fourteen (6%) patients underwent a hybrid procedure. Use of endovascular versus open procedures did not increase over the duration of the study (p = 0.248). In-hospital mortality rate was 10%. Graft or stent thrombosis occurred in 7% and graft or stent infection occurred in 3% of patients. Mean follow-up was 1.6 ± 2.4 years (n = 150). Limb salvage was achieved in 216 (97%) patients. The management of subclavian and axillary artery injuries still requires a wide variety of open exposures and procedures, especially for the control of active hemorrhage from more than 50% vessel lacerations and transections. Endovascular repairs were used most often for pseudoaneurysms. Low early complication rates and limb salvage rates of 97% were observed after open and endovascular repairs. Prognostic/epidemiologic, level IV.

A Comparative Analysis of Open versus Endovascular Techniques for Management of Non-Aortic Cervicothoracic Arterial Injuries

The objective of this study is to describe the contemporary management of proximal upper extremity and neck arterial injuries by comparing open and endovascular repair at a single institution. This is a retrospective study of 22 patients that sustained subclavian, axillary, and carotid artery injuries from 2011 to 2016 that were managed with open or endovascular repair. There were nine subclavian, eight axillary, and five carotid artery injuries of which 10 (45.5%) underwent endovascular repair and 12 (54.5%) underwent open repair. There was no statistically significant difference between the groups including injury severity score or preoperative hypotension. There were no deaths in the endovascular group, and three (25.0%) deaths in the open group. All patients in the endovascular group were discharged home. In the open group, seven (58.3%) patients had at least one inpatient complication with a mean of 1.1 (standard deviation 1.4) complications per patient. In the endovascular group, there were three (30.0%) patients with inpatient complications and a mean of 0.4 (standard deviation 0.7) complications per patient (P = 0.18). Endovascular management of nonaortic cervicothoracic arterial injuries was successfully performed in hypotensive patients and patients with other life threatening traumatic injuries. Further studies are warranted to look at long-term patency of these repairs and to help develop a protocol to guide decision-making in the management of cervicothoracic injuries.

Embolic Infarction with Hypercoagulability Caused by Subclavian Pseudoaneurysm

Traumatic subclavian artery injury is a rare complication of clavicular fracture. An arterial injury can present as a pseudoaneurysm, which can cause a hypercoagulable state, thrombus formation, deep vein thrombosis, and distal embolism. We report a case of subclavian artery pseudoaneurysm that presented as embolic stroke in a 81-year-old man at 2015 1Â month after clavicular fracture. Key Words: Pseudoaneurysm, Stroke

Pellet Embolization after Subclavian Artery Injury: A Case Report

Acute upper limb ischemia caused by a gunshot penetrating vascular injury and subsequent arterial embolization by foreign body is uncommon in everyday practice and is associated with high morbidity/mortality rates, especially with emergency surgery. We present the case of a 72-year old male who attempted suicide using a gun. A gunshot entry wound was evident in the right upper chest region with no pellet exit wound. Radial pulses were palpable bilaterally. Angiography revealed right subclavian artery direct injury and pellet embolization to the brachial artery. The patient underwent open surgery, with reversed saphenous vein interposition graft to replace subclavian artery defect. A pellet was removed by a separate arteriotomy in the brachial artery. Associated injuries were clavicle-comminuted fracture and subclavian vein injury. The patient remained well 5 months later with no reported complications. In conclusions, the presence of radial pulses alone on clinical exam cannot rule out the presence of a significant vascular injury.

Contemporary management of civilian penetrating cervicothoracic arterial injuries

The management of arterial injury at the thoracic outlet has long hinged on the fundamental principles of extensile exposure and vascular anastomosis. Nonetheless, treatment options for such injuries have evolved to include both endovascular stent placement and temporary vascular shunts. The purpose of this study was to evaluate our recent experience with penetrating cervicothoracic arterial injuries in light of these developments in trauma care. Patients with penetrating injuries to the innominate, carotid, subclavian, or axillary arteries managed at a single civilian trauma center between 2000 and 2013 were categorized as the modern era (ME) cohort. The management strategies and outcomes pertaining to the ME group were compared to those of previously reported experience (PE) concerning injuries to the innominate, carotid, subclavian, or axillary arteries at the same institution from 1974 to 1988. Over the two eras, there were 202 patients: 110 in the ME group and 92 in the PE group. Most of the injuries in both groups were managed with primary repair (45% vs. 46%; p = 0.89). A similar proportion of injuries in each group was managed with anticoagulation alone (14% vs. 10%; p = 0.40). In the ME group, two cases were managed with temporary shunt placement, and endovascular stent placement was performed in 12 patients. Outcomes were similar between the groups (bivariate comparison): mortality (ME, 15% vs. PE, 14%; p = 0.76), amputation following subclavian or axillary artery injury (ME, 5% vs. PE, 4%; p = 0.58), and posttreatment stroke following carotid injury (ME, 2% vs. PE, 6%; p = 0.57). Experience with penetrating arterial cervicothoracic injuries at a high-volume urban trauma center remained remarkably similar with respect to both anatomic distribution of injury and treatment. Conventional operative exposure and repair remain the cornerstone of treatment for most civilian cervicothoracic arterial injuries. Therapeutic study, level V.

The potential risk of left subclavian artery injury from excessively long thoracic pedicle screws placed in the proximal thoracic regions of Lenke type 2 adolescent idiopathic scoliosis patients and normal teenagers: an anatomical study.

The altered anatomic positions of important structures adjacent to the vertebrae in adolescent idiopathic scoliosis (AIS) patients have been comprehensively investigated by previous radiographic studies. However, no study has evaluated the altered position of left subclavian artery (SA) in these patients. The purpose of this study is to evaluate the altered position of left subclavian artery in AIS patients with a double thoracic curve pattern. Nineteen Lenke type 2 AIS patients and thirteen normal teenagers were included in this study. Axial computed tomography images at T2 and T3 levels were obtained in all these subjects to evaluate the subclavian artery-vertebral angle (SAVA, defined as 0° when the artery was located directly lateral to the left and 180° when directly lateral to the right) and subclavian artery-vertebral distance (SAVD, the shortest distance between the artery and vertebral body). The percentage of left subclavian arteries at potential risk of injury from excessively long pedicle screws was calculated. The SAVA was significantly larger in AIS patients than that in normal teenagers at both T2 and T3 levels (P<0.05) while the SAVD was significantly smaller in AIS patients compared with normal teenagers at both T2 and T3 levels (P<0.05). The left SA was at potential risk of injury from excessively long left pedicle screws in 6 (31.6%) AIS patients at T2 level and in 10 (52.6%) patients at T3 level. The patients with risk of left SA injury had larger proximal thoracic (PT) and larger AVT of PT curve when compared with those without. No left SA was at potential risk of injury from excessively long left pedicle screws in normal teenagers. The left SA is located much closer to the vertebrae in the proximal thoracic curve of Lenke type 2 AIS patients when compared with normal teenagers. The spine surgeons should be aware of such altered position of left SA and choose appropriate pedicle length to avoid anterior cortical penetration in Lenke type 2 AIS patients.

Percutaneous repair of iatrogenic subclavian artery injury by suture-mediated closure device.

Central venous catheterization through internal jugular vein is done routinely in intensive care units. It is generally safe, more so when the procedure is performed under ultrasound guidance. However, there could be inadvertent puncture of other vessels in the neck when the procedure is not performed under real-time sonographic guidance. Closure of this vessel opening can pose a challenge if it is an artery, in a location difficult to compress, and is further complicated by deranged coagulation profile. Here, we discuss the removal of an inadvertently placed catheter from subclavian artery with closure of arteriotomy percutaneously using arterial suture-mediated closure device.