Analysis of Traumatic Axillo-Subclavian Vessel Injuries: Endovascular Management is a Viable Option to Open Surgical Reconstruction

Boggs, Hans K.; Tomihama, Roger T.; Abou-Zamzam, Ahmed M.; Mukherjee, Kaushik; Turay, David; Teruya, Theodore H.; Magtanong, Emelyn; Pop, Andrew; Kiang, Sharon C.

doi:10.1016/j.avsg.2021.07.047

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…This contrasts with the previously reported historical mortality rate of 34%, which could be explained by improved trauma care, improved vascular care, or by increased identification of injuries, including minimal injuries managed non-operatively, with increased utilization of CT scans over time. 3,13 Our revascularization technical success rate (97%), stent/ graft thrombosis rate (6%), and infection rate (0%) were similar to studies from Waller et al and Boggs et al 2,8 In a retrospective review including 3807 patients, Grigorian et al showed that overall rate of limb loss for axillosubclavian arterial injury was 2.4% with risk factors being a concomitant axillosubclavian vein injury, humerus fracture, and open approach. 15 In our study, of the three patients requiring endovascular to open conversion, two required amputations, which were the only two patients in the study undergoing amputation.…”

Section: Discussionsupporting

confidence: 81%

“…Individual patient factors, hemodynamic stability, injury type/grade, and overall trauma burden are considered when determining the management approach. 2,7,8 There continues to be limited data available pertaining to patient outcomes based on injury pattern and management techniques specifically for traumatic axillary and subclavian artery injuries. The main objectives of this study are to compare patient and injury characteristics, as well as management strategies and outcomes in patients with traumatic axillary and subclavian artery injuries at an urban Level One trauma center.…”

Section: Introductionmentioning

confidence: 99%

“…6 Some studies have evaluated endovascular approaches specifically for traumatic axillo-subclavian arterial injury and have shown them to be safe with a high revascularization rate, low infection risk, lower blood loss, and shorter length of stay when compared with traditional open approaches. 7,8 However, not all axillo-subclavian injuries are amenable to endovascular or hybrid repair and may require an open approach. Individual patient factors, hemodynamic stability, injury type/grade, and overall trauma burden are considered when determining the management approach.…”

Section: Introductionmentioning

confidence: 99%

“…Individual patient factors, hemodynamic stability, injury type/grade, and overall trauma burden are considered when determining the management approach. 2,7,8…”

Section: Introductionmentioning

confidence: 99%

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Contemporary Review of Traumatic Axillary and Subclavian Artery Injuries at an Urban Level One Trauma Center

Boudreau,

Schucht,

Sigdel

et al. 2024

Vasc Endovascular Surg

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Objective Traumatic axillary and subclavian artery injuries are uncommon. Limited data are available regarding patient and injury characteristics, as well as management strategies and outcomes. Methods Retrospective chart review was performed on patients presenting to University of Louisville Hospital, an urban Level One Trauma Center, with traumatic axillary and subclavian artery injuries from 2015-2021. Patients were identified using University of Louisville trauma, radiology, and billing database searches based on ICD9/10 codes for axillary and subclavian artery injuries. Descriptive statistics are expressed as frequencies and percentages. Comparisons were performed using Fisher’s Exact and Chi-squared tests. Results Forty-four patients with traumatic axillary-subclavian arterial injuries were identified for analysis. Blunt and penetrating trauma were equally represented (n = 22 for both). A variety of injury types were seen, including minimal/intimal injury, laceration, pseudoaneurysm, transection, occlusion, and arteriovenous fistula. Management strategies were also variable, including non-operative, endovascular, planned hybrid, open, and endovascular converted to open. In operative patients, revascularization technical success was high (n = 31, 97%) with low likelihood of thrombosis (n = 2, 6%) and no infections. Among all patients, amputation rate was 5% (n = 2) and mortality rate was 9% (n = 3). Regarding arterial involvement, blunt injury was more likely to affect the subclavian (n = 18) than the axillary artery (n = 6) ( P = .04). No significant difference was seen in brachial plexus injury based on artery involved (subclavian = 9 vs axillary = 11, P = .14) or mechanism (blunt = 6 vs penetrating = 11, P = .22). Non-operative management was more likely with subclavian artery injury (n = 11) vs axillary artery injury (n = 1) ( P = .008). There was no significant difference between decision for non-operative (blunt = 9, penetrating = 3) vs operative (blunt = 13, penetrating = 19) management based on mechanism ( P = .09). Transection injury was associated with an open repair strategy (endovascular/hybrid = 1, open/endovascular to open conversion = 11, P = .0003). Of the three patients requiring endovascular to open conversion, two required amputation, which were the only two patients in the study undergoing amputation. Conclusions Both open and endovascular/hybrid strategies are useful when treating traumatic axillary and subclavian artery injuries and are associated with high likelihood of revascularization technical success, with low rates of thrombosis or infection, when treated promptly at a trauma center with vascular specialists available. Transection injuries were most often treated with open revascularization. Patients undergoing amputation had blunt transection injuries to the subclavian artery and underwent endovascular to open conversion after failed attempts at endovascular revascularization.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Individual patient factors, hemodynamic stability, injury type/grade, and overall trauma burden are considered when determining the management approach. 2,7,8…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Contemporary Review of Traumatic Axillary and Subclavian Artery Injuries at an Urban Level One Trauma Center

Boudreau,

Schucht,

Sigdel

et al. 2024

Vasc Endovascular Surg

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show abstract

“…1 The growth of endovascular techniques in the management of blunt thoracic aortic injury and axillo-subclavian vessel injury has widened the breadth of vascular trauma practice while reducing experience with open vascular trauma techniques for both practitioners and trainees. 2,3 There has been a decrease in operative exposure of general surgery trainees to vascular trauma procedures, and a limited number of vascular trauma cases are performed in trauma/critical care fellowship. 4,5 The greater involvement on the part of vascular surgeons in the management of vascular trauma has paralleled the growth of endovascular procedures.…”

Section: Introductionmentioning

confidence: 99%

Managing Vascular Trauma: Trauma Surgeons versus Vascular Surgeons

Harfouche

Kauvar

Feliciano

et al. 2022

The American Surgeon

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Objectives Changes in vascular trauma care and trainee exposure to vascular surgery have raised questions regarding who should take care of vascular trauma patients. This study aimed to determine nationwide trends and perceptions regarding the management of vascular trauma amongst vascular and trauma surgeons. Material and Methods Online surveys were administered to trauma surgeons through the American Association for the Surgery of Trauma (AAST) and to vascular surgeons through the Vascular and Endovascular Surgery Society (VESS) and Western Vascular Society (WVS) in February 2021. Demographics, practice-related information, and interest in, experience and comfort level with vascular trauma were queried. Trainees and those practicing outside the United States were excluded. Results were analyzed using Stata/BE v16.1. Results 247 surgeons were included in the final study population, of which 163 (66%) were trauma surgeons (T) and 84 (34%) were vascular surgeons (V). Vascular surgeons were younger (46 v 51y, P < .001) and had fewer years in practice (10 v 17y, P < .001). Vascular surgeons had greater experience and comfort with managing vascular trauma, but less interest in both vascular and endovascular trauma care when compared to trauma surgeons. Inability to maintain skillset (27%) and unfamiliarity with techniques (32%) were the most common barriers to practicing vascular trauma cited by trauma surgeons. Discussion Despite significant interest in practicing vascular trauma amongst trauma surgeons compared to vascular surgeons, most feel unprepared to do so. Collaboration between vascular and trauma surgeons could close the experience gap and appeal to the interests of both groups.

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Endovascular treatment of axillosubclavian arterial injuries is a safe alternative to open repair

Siada

Dirks

Davis

et al. 2022

The American Journal of Surgery

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Analysis of Traumatic Axillo-Subclavian Vessel Injuries: Endovascular Management is a Viable Option to Open Surgical Reconstruction

Cited by 8 publications

References 14 publications

Contemporary Review of Traumatic Axillary and Subclavian Artery Injuries at an Urban Level One Trauma Center

Contemporary Review of Traumatic Axillary and Subclavian Artery Injuries at an Urban Level One Trauma Center

Managing Vascular Trauma: Trauma Surgeons versus Vascular Surgeons

Endovascular treatment of axillosubclavian arterial injuries is a safe alternative to open repair

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