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

Abstract

Background: Blunt thoracic arterial injuries are among the rare causes for presentation at trauma centers. Most of the literature on these injuries is in the form of case reports and case series, with no significantly consolidated data available. Methods: A systematic review of English language case reports and case series from 2000 to 2019 was carried out using the PubMed and Google Scholar search engines. Results: The mean patient ages were 35.9, 36.4, and 44.3 years for thoracic aorta, innominate, and subclavian artery injuries, respectively. Of the innominate artery injury patients, 89.7% were male. Motor vehicle-related injuries contributed to 50.9% of thoracic aortic injuries. A blood pressure/pulse deficit was recorded in 34.8% and 20.7% of patients with subclavian and innominate artery injuries, respectively, and chest pain and hemodynamic instability were found in 23.5% and 20.5% of aortic injury patients, respectively. Clavicular fracture was the most common associated finding in subclavian artery injury patients at 42%. Computed tomography was performed in 21.7%, 47.1%, and 27.6% of patients with subclavian artery, thoracic aorta, and innominate artery injuries, respectively. An endovascular intervention was performed in 44.1% of patients with subclavian artery injuries. Conclusion: Injury to the subclavian artery is relatively common among the older population. Blood pressure or pulse discrepancies could point to either subclavian or innominate artery injury. An endovascular intervention can be considered in all patients but must be individualized based on patient and facility factors.