Acute subclavian artery occlusion with associated clavicle fracture managed with bypass graft alone

Abstract

Subclavian artery injury is a rare consequence of clavicle fracture. It most often results from penetrating trauma but can result from blunt trauma with adjacent bone fragments causing rupture, pseudoaneurysm, dissection or thrombosis of the artery. If flow through the subclavian artery is compromised there is a risk of ipsilateral upper limb ischaemia. Life-threatening haemorrhage may result in cases of laceration, and cerebral infarction may result from dissection. Vascular injury in association with clavicle fracture is typically regarded as an indication for internal fixation of the fracture. We present a case of subclavian artery thrombosis in association with a comminuted midshaft clavicle fracture causing limb ischaemia managed by carotid to brachial artery bypass without internal fracture fixation. The fracture united at 4 weeks and there was no sustained vascular or neurological impairment at follow-up. We advocate urgent vascular intervention in subclavian artery injury. There is little discussion in the literature regarding non-operative management of clavicle fractures with subclavian artery injury. We suggest that select clavicle fractures with subclavian artery injury can be safely managed non-operatively.

Successful management with endovascular stent graft repair following gunshot wound to the subclavian artery: Case report and literature review

“…In addition, due to its relatively recent introduction into the clinical market, the lack of long-term data on outcomes continues to be of concern [17]. Another downside of endovascular approaches is that the damaged vessel itself cannot be directly visualized and also injury to adjacent structures cannot be directly seen as would be with an open surgical repair [18]. Further, the proximity of the vertebral artery to the subclavian artery predisposes it to branch vessel coverage which can potentially lead to a cerebrovascular incident [8].…”

“…Failure of endovascular repair is typically the result of an inability to pass the guidewire across the length of the lesion [3]. Notwithstanding, endovascular approaches offer several advantages over open approaches such as remote access, shorter operative time, less blood loss, lower incidence of sepsis, and a reduced risk of injury to surrounding structures [2,3,8,14,[17], [18], [19], [20], [21]]. Additionally, quicker recovery time and a decreased length of hospital stay are associated with endovascular approaches [22].…”

Clinic furniture arrangements leading to patient self-reported blood pressure discrepancy: a rare case of total occlusion of left subclavian artery

“…After three years of follow ups, she remains asymptomatic and free of cardiovascularrelated complications.Subclavian occlusions can be caused by atherosclerosis with arterial plaque formation or non-atherosclerotic reasons such as fibro-muscular dysplasia, trauma, radiation exposure, Takayasu's arteritis, vasculitis, and neurofibromatosis (Caesar-Peterson et al, 2021;Mubarik & Iqbal, 2021;Shadman et al, 2004). Physical examination could reveal a left and right arm blood pressure (BP) discrepancy.Most reported cases of subclavian artery occlusion are of symptomatic cases and discussion focuses on treatment of the occlusions (Ahmed et al, 2016;Buchanan et al, 2018). There is a lack of reported cases of asymptomatic total subclavian artery occlusions, especially a case that includes the follow-up period.We report a case of a 58-year-old lady with asymptomatic total occlusion of the left subclavian artery that was found incidentally during investigations for right and left BP discrepancies in a primary care clinic.…”

“…Most reported cases of subclavian artery occlusion are of symptomatic cases and discussion focuses on treatment of the occlusions (Ahmed et al, 2016;Buchanan et al, 2018). There is a lack of reported cases of asymptomatic total subclavian artery occlusions, especially a case that includes the follow-up period.…”