Subclavian vascular injuries

Abstract

This study comprises 228 patients with penetrating injuries of the subclavian vessels. The vein alone was involved in 44 per cent, the artery alone in 39 per cent, and both vessels in 17 per cent. The majority of the victims (61 per cent) did not reach the hospital alive, and in those who were operated on the mortality was 15.5 per cent (overall mortality 66 per cent). The overall mortality of venous injuries was significantly higher than the arterial ones (P less than 0.01), probably because of the dangerous complication of air embolism. Physical examination is reliable in the diagnosis of these injuries and there is no need for an emergency angiogram. The clavicular incision was the preferred approach. Repair was performed in 94 per cent of those with arterial injury. Vein injuries were treated by suture in 60 per cent and ligation in 40 per cent. A selective conservative approach is advised.

Answer

“…Upper extremity neurological deficits are found in slightly more than half of patients, the majority related to brachial plexus injury. 4 Definitive diagnosis is made by angiography because overlying air-filled lungs often preclude ultrasound visualization and the sensitivity of the ABI (ankle brachial index) is affected by collateral blood flow. One retrospective study of 100 patients with periclavicular trauma found that a normal physical exam coupled with a normal chest x-ray eliminated the need for angiography and would not have missed any vascular injuries.…”

Subclavian vessel injuries: difficult anatomy and difficult territory

“…Busy urban trauma centers report admitting between two and four subclavian vascular injuries per year, although some international trauma centers have reported admitting as high as four patients per month [4,5,15,24]. Subclavian artery injury specifically accounts for 1-2% of all acute vascular injuries [3,4,8,9,26,27]. While the majority of these injuries are penetrating, up to 25% are related to a blunt mechanism of injury [14].…”

“…The low incidence of subclavian artery injury is primarily explained by the anatomic location and the protective barrier provided by the clavicle and thoracic cage. In a study combining both prospective and retrospective reviews, Demetriades [9] reported that isolated subclavian vein injuries were present in 44% of the patients, isolated subclavian artery involvement in 39%, and combined injuries in approximately 17% of the cases. On the other hand, Lin et al [23] reported that 24 of 54 patients presenting with subclavian artery injuries also sustained associated venous injuries.…”

“…On the other hand, blunt subclavian artery injuries occur far less frequently. Urban trauma centers report that approximately 1-3% of all traumatic subclavian artery injuries result from blunt trauma [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. The relatively low incidence of blunt vascular trauma is due to the protected anatomic location of the subclavian vessels.…”

Pellet Embolization after Subclavian Artery Injury: A Case Report

“…Penetrating vascular injuries are associated with high mortality rates, with a significant percentage of patients dying before reaching the hospital [1] [2]. Moreover, gunshot vascular injuries may be associated with bone, nerve and muscu-Surgical Science lotendinous damage and treating these complex injuries usually requires a multidisciplinary team approach [3].…”