Subclavian Arterial Injury Associated with Blunt Trauma

Abstract

Blunt subclavian artery trauma is an uncommon but challenging surgical problem. The purpose of this study was to retrospectively review the management of blunt subclavian artery injuries treated by the Trauma and Vascular Surgery Services at the East Tennessee State University-affiliated hospitals between 1992 and 1998. Six patients with seven blunt subclavian artery injuries were identified. Physical signs indicating blunt subclavian artery injury were pain or contusion around the shoulder joint; fractures of the clavicle, scapula, or ribs; periclavicular hematomas; and ipsilateral pulse or neurologic deficits. Seven subclavian artery injuries were treated-two arterial transections, two pseudoaneurysms, and three intimal dissections. Associated injuries included four clavicle fractures, one humerus fracture, one combined rib and scapular fractures, and two pneumothoraxes. Vascular surgical treatment included three primary arterial repairs, two saphenous vein interposition grafts, and one polytetrafluoroethylene (PTFE) graft. One patient was treated nonoperatively with anticoagulation. No deaths occurred. Morbidity occurred in two patients with chronic upper extremity neuropathy producing prolonged disability from pain and weakness; one patient had reflex sympathetic dystrophy, and the other had a brachial plexus injury. In conclusion, blunt subclavian artery trauma can be successfully managed with early use of arteriography and prompt surgical correction by a variety of vascular techniques. Vascular morbidity is usually low, but long-term disability because of chronic neuropathy may result from associated brachial plexus nerve injury despite a successful arterial repair.

A Case of Subclavian Artery Injury Due to Blunt Trauma Treated Successfully by Endovascular Repair

“…The majority of subclavian artery injuries occur with penetrating trauma, with 1-5% resulting from blunt mechanisms 1,2) . Blunt subclavian artery injuries are less common in the proximal portion of the artery than in the middle or distal portions 1) .…”

“…Subclavian artery injury is rare, but can cause both limb-and life-threatening conditions due to rupture into the thoracic cavity 1,2) . Endovascular techniques Received: July 12, 2011/Accepted: March 1, 2012 Correspondence to: Masayoshi Nishina Tokyo Women's Medical University Medical Center East Emergency and Critical care Center, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan have recently been used to successfully treat vascular injury 3) .…”

Trombose venosa da veia subclávia após fratura de clavícula: relato de caso

“…Neurovascular injuries associated with closed fractures of the clavicle are rare (1)(2)(3) and are associated mainly with penetrating traumas (4)(5)(6)(7) . The most common injury mechanism is falling onto the palm of the hand, or onto a point on the shoulder, or direct or indirect traumas associated with contact sports (1,3,8) .…”

Subclavian artery and vein injury following clavicle fracture due to blunt trauma

“…Damage to neurovascular structures associated with closed fractures of the clavicle due to blunt trauma is rare, 3,4,8 and are more frequently related to penetrating injuries. 1,[5][6][7] The usual mechanisms of injury include fall on an outstretched hand or on the point of the shoulder, and direct or indirect trauma associated with contact sports. 3,8 To the best of authors' knowledge, the incidence of subclavian vascular injury in closed fractures of clavicle has not been documented in the literature.…”