Endovascular Repair of a Penetrating Axillary Artery Injury

Abstract

We report a 16-year-old boy who sustained a gunshot injury on his upper left side of the chest that resulted in an injury to the left axillary artery and was treated with endovascular repair. An endovascular repair has been increasingly accepted for the management of hemorrhage in critically ill trauma patients; using covered endovascular stents provides an alternative modality for both controlling hemorrhage and preserving flow.

Endovascular Instead of Open Surgical Repair of Axillosubclavian Artery Injuries: An Evolving Paradigm Shift

“…Moreover, patients with large hematomas at risk of compressing the brachial plexus and leading to persistent neurologic deficits may also require OSR rather than EVR to evacuate it [13]. Whereas hemodynamic instability was previously cited as a contraindication to EVR, now, in the era of EVTM and hybrid ORs, it is an evolving indication [33][34][35]. With innovations such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and proximal balloon occlusion of the subclavian artery, it is becoming more realistic to take unstable patients for hybrid or EVR [12,28] even with active extravasation and expanding hematoma [36].…”

“…Patients receive varied durations of antiplatelet therapy thereafter, ranging from 1 month to lifelong [6,17,39]. Follow up is limited in most cases with a wide range, from none post-discharge to 6 years [35,39].…”