Aggressive management of vascular injuries of the thoracic outlet

Abstract

The use of angiography helps to confirm and localize injuries. Prompt correction of the vascular injury avoids disability resulting from ischemia. Although the amputation rate is low with vascular repair, the functional disability resulting from associated nerve injuries can be devastating.

Urgent endovascular stent-graft placement for traumatic penetrating subclavian artery injuries

“…In the presented series, all the patients sustained SA injuries due to penetrating trauma. Associated injuries, include injury to brachial plexus, aerodigestive tract, sympathetic chain and spinal cord [1,2,7,9,11]. In this series all the six patients presented associated lung injury (lung contusion, pneumothorax or hemothorax) and three of them presented brachial plexus injury.…”

“…The endovascular approach to SA injuries limits the risk of operative damage to surrounding structures and the potential for blood loss. Direct surgical access to a poorly contained arterial laceration or to a poorly endothelialized recently formed pseudoaneurysm, carries a high risk of perioperative rupture [1][2][3][4][5][6][7]. The surgeon must be ready for reconstructive or bypass surgery.…”

“…Penetrating injuries to the subclavian artery (SA) are relatively uncommon but may be associated with considerable morbidity and mortality [1][2][3]. When active bleeding or critical limb ischemia is evident, urgent surgical repair has been considered the treatment of choice.…”

Endovascular repair of the left subclavian artery after gunshot wound: an alternative to surgical treatment

“…Such traumas lead to various types of lesion, including arterial wall rupture, intimal tearing, dissection, pseudoaneurysms and/or the development of arteriovenous fistulas. Associated lesions include injuries to the brachial plexus and the aerodigestive tracts [3][4][5][6][7] . Subclavian artery lesions are feared because they are associated with a high morbidity and mortality rate, and because adequate surgical exposure is difficult to obtain.…”

Temporary Thoracoscopic Control of the Proximal Left Subclavian Artery for Trauma

“…[2][3][4] Patients fortunate enough to reach surgical intervention have a mortality of 5% to 30% and the mortality is extremely high in those undergoing resuscitative thoracotomy. [5][6][7][8][9] Patients who survive the injury experience considerable morbidity often involving brachial plexus, phrenic nerve, thoracic duct, and occasionally limb loss. 10 -12 These complications are some- Controversies regarding the management of neck injuries date back 4.5 centuries when Ambroise Paré ligated the common carotid and jugular vein and subsequently Flemming ligated the carotid artery with postoperative morbidity and success respectively.…”