Nonpenetrating subclavian artery trauma

Abstract

Nonpenetrating injury to the subclavian vessels is uncommon. During a 6-year period we have treated 167 patients with injuries to the subclavian and superior mediasfinal arteries. Fifteen of these injuries (9%) occurred after blunt trauma. In 10 patients the proximal segment (first and second parts) of the artery was involved. No patient had an isolated injury; the most frequent associated injuries were rib fractures (n = 11), with the first rib being involved in four of these. Total brachial plexus disruption was found in nine patients. All patients with distal artery involvement had a clavicular fracture. All had an absent radial pulse and eight had critical ischemia ofthe hand. Four patients were treated nonoperatively and the remainder were treated along standard lines. Brachial plexus reconstruction was not feasible in any patient. Within 2 weeks of operation, one patient died as a result of head injuries and one required amputation because of sepsis, During a 12-month period, five regained fifll function, one additional patient requested above-elbow amputation after 6 months, and seven had a flail anesthetic limb. Twelve of these patients were involved in automobile accidents, eight of whom were wearing lap~ shoulder harness seat belts with a loose-fitting shoulder strap component that created a characteristic abrasion pattern on the torso and chest. We conclude that the torsionshearing motion allowed by this situation contributed significantly to the pattern of injury and a plea is made for correctly fitted restraining devices.

Subclavian Arterial Injury Associated with Blunt Trauma

“…In all of these situations, clinical suspicion is needed because subclavian arterial trauma may be masked by the excellent collateral circulation to the upper extremity around the shoulder. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] Other serious or even life-threatening injuries can also occur in approximately 50% of patients with subclavian artery trauma and may also mask the subtle signs of vascular injury.2-8,16,18 Ipsilateral upper rib and clavicle fractures are most common. 2,47,8,11,12 Neurologic deficits, especially involving the brachial plexus, should also raise the suspicion of a subclavian artery injury.…”

Brachial Plexus Injury: Long-Term Functional Outcome is Determined by Associated Scapulothoracic Dissociation

“…All 11 had musculoskeletal injuries resulting from rotational or lateral displacement of the shoulder girdle consistent with SD. Skeletal injuries included scapula fractures (8), clavicle fractures (6), scapular displacement (4), and acromioclavicular separation (3). Eight patients underwent angiography for abnormal physical examination findings suggestive of vascular injury.…”

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

“…Additionally, the axillary and subclavian arterial axis is prone to stretch/traction forces that may result from shear/deceleration trauma or from isolated shoulder impact. 3,7 Resulting arterial injuries may be proximal, and not associated to bone or soft tissue lesions. These types of forces may explain the pathophysiology of the lesions found in cases 1 and 3 of our report.…”

“…1---5 Most cases are caused by penetrating mechanisms, with only up to 5% of these injuries produced by blunt trauma. 3,6 Blunt trauma may involve multiple structures but presentation of a subclavian or axillary arterial lesion may not be clinically notorious, 3 delaying diagnosis and adversely affecting patient outcome. 7 Direct surgical repair of these vessels requires extensive exposure obtained through frequently traumatized tissues which is not free from complications.…”