Feasibility of endovascular repair in penetrating axillosubclavian injuries: A retrospective review

Danetz, Jeffrey S.; Cassano, Anthony D.; Stoner, Michael C.; Ivatury, Rao R.; Levy, Mark M.

doi:10.1016/j.jvs.2004.11.026

Cited by 103 publications

(89 citation statements)

References 21 publications

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“…mas an endovascular treatment was possible but was performed in only 2 cases. The surgeon's preference to open surgery or lack of endovascular services probably accounted for the low incidence of endovascular treatment [38].…”

Section: Resultsmentioning

confidence: 99%

Endovascular Treatment of Blunt Traumatic Injury to the Brachial Artery: Case Report and Review of the Literature

Smeets¹

2017

Clin Med Rev Case Rep

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Blunt traumatic injury to the subclavian, axillary or brachial artery is uncommon and could have devastating consequences. Historically open repair is performed however reports of successful endovascular treatments are increasing. A case is described of a seventy one-year-old patient with a blunt injury to his right arm after being crushed in a closing hydraulic door of a truck. He sustained a traumatic dissection of his right brachial artery with associated nerve injury to the brachial plexus. After trauma resuscitation he was successfully treated in the hybrid operation room. Through the common femoral artery a helical stent (Supera) was placed in the injured brachial artery. Postoperative recovery was without complications. Additional treatment for the nerve injury was performed several months after trauma by the neurosurgeon. Functional recovery of his right arm was good except for fine motoric functioning which is still recovering.A review of the literature was performed to identify endovascular repair of blunt traumatic injury to the upper extremity. A total of 28 papers described 55 patients who underwent 56 procedures for subclavian, axillary and brachial injuries. The subclavian artery was affected and treated in 36 patients, in 16 patients axillary injury was treated and only 4 brachial arteries received endovascular repair. Technical success rate of endovascular treatment is good and stent graft patency rates are sufficient. Type of injury which was treated, the follow up technique, anticoagulant therapy and follow up duration varied extensively in the literature. Endovascular treatment of blunt arterial trauma to the upper extremity appears to be feasible. No definite conclusion can be drawn concerning best type of stent graft, best follow up regime or post-operative medical treatment. Treating a patient in a hybrid operation room seems advisable to facilitate conversion to open treatment or treat associated traumatic injuries if necessary.

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Section: Resultsmentioning

confidence: 99%

Endovascular Treatment of Blunt Traumatic Injury to the Brachial Artery: Case Report and Review of the Literature

Smeets¹

2017

Clin Med Rev Case Rep

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“…17,18 Vascular repair may require extensive paraclavicular incisions for control; dissection though hematoma-distorted planes is feasible but not without a significant risk of neurovascular injury and significant hemorrhage. 21 In comparison, endovascular treatment is a safe and attractive alternative to conventional surgery in trauma patients. 17,19 Endovascular repair has been defended as the first choice of treatment for stable patients 17 however, appropriate patient selection for endovascular approach is critical.…”

Section: Discussionmentioning

confidence: 99%

“…20 Indications for potential endovascular repair include pseudoaneurysm, arteriovenous fistula, first-order branch vessel injury/avulsion, arterial intimal flap and focal arterial injury. 21 Active uncontrollable hemorrhage, limbthreatening ischemia, airway or brachial plexus compression, concomitant aero-digestive injuries or infected wounds have all been cited as contraindications for endovascular management. 17 Additionally, arteriographic contraindications include excessive luminal discrepancy between the proximal and distal arterial involvement site, inability to cross the lesion with a guidewire 17 and acute occlusion.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries

Oliveira

Rodrigues

Gonçalves

et al. 2014

Angiologia e Cirurgia Vascular

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Introduction: Blunt trauma of the axillary and subclavian arteries is uncommon. Conventional surgery presents significant morbidity associated to the need of extensive exposure and challenging dissection through traumatized tissues. Endovascular treatment is an alternative that has increasingly been used in traumatic arterial injuries. This report presents three cases that were managed by endovascular techniques. Methods: We report the cases of three patients with blunt traumatic injuries of the subclavian and axillary arteries who were treated at our Institution in 2013 with endovascular techniques. Each case presented distinctly, resulting from different traumatic mechanisms and the therapeutical approach was adapted accordingly. Results: Case 1: A 68-year-old man was admitted with an acute limb ischemia of the left upper limb after a fall from his own walking height. A computerized tomography angiography demonstrated a dissection of the left subclavian artery. Resource to a proximal angioplasty with stent allowed the recovery of the limb perfusion fixating the flap. Case 2: A 34-year-old male who fell from a height of 8 m, with multiple costal arch fractures and the complete transection of the subclavian artery. In this case, a covered stent excluded the rupture. Case 3: A 45-year-old woman presented to our department with an acutely ischemic left upper limb with 3 days of progression after a distension of the scapuloh-umeral articulation. Although a digital amputation was ultimately necessary, hand-salvage was accomplished through thrombectomy and catheter-directed thrombolysis. Conclusion: Blunt trauma of the axillosubclavian arteries is rare and its diagnosis may be challenging. Endovascular treatment of blunt traumatic injuries of the subclavian and axillary

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“…The most common contraindications are long segmental injuries, complete transections and the absence of an adequate proximal fixation zone 8 . For some authors, haemodynamic instability is a contraindication for endovascular treatment 14 . For others, on the contrary, patients presenting with partially controlled bleeding can be monitored and stabilised in the catheterisation room as well as in the operating theatre.…”

Section: Conflicts Of Interest: Nonementioning

confidence: 99%

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

et al. 2012

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Penetrating injuries of the subclavian artery are associated with a high morbidity and mortality rate. Endovascular treatment with covered stents (stent grafts) has emerged as an eff ective alternative to surgery, but this new technique is not exempt from complications. We report the case of a male gunshot victim, treated by a covered stent for haemorrhagic shock due to partial subclavian rupture.

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Feasibility of endovascular repair in penetrating axillosubclavian injuries: A retrospective review

Cited by 103 publications

References 21 publications

Endovascular Treatment of Blunt Traumatic Injury to the Brachial Artery: Case Report and Review of the Literature

Endovascular Treatment of Blunt Traumatic Injury to the Brachial Artery: Case Report and Review of the Literature

Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries

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

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