Surgical Exposure of the Left Subclavian Artery by Median Sternotomy and Left Superaclavicular Extension

Hajarizadeh, Homayon; Rohrer, Michael J.; Cutler, Bruce S.

doi:10.1097/00005373-199607000-00022

Cited by 19 publications

(10 citation statements)

References 9 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Injury to the subclavian artery following blunt trauma is uncommon and accounts for only 2% to 3% of all reported subclavian artery injuries. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Penetrating trauma of the subclavian artery is at least 50 times more common. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The largest published series of subclavian artery injuries includes 93 cases of which only two were secondary to blunt trauma.3 This relatively low incidence of blunt subclavian artery injury has been attributed to the protection conferred by its anatomic location within the shoulder girdle.3'8 '12-14 Two theoretical mechanisms for blunt subclavian artery injury have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…Proximal left subclavian artery control may be obtained by an anterior thoracotomy through the third or fourth interspace.2-17 Another approach is via a median sternotomy combined with a left supraclavicular extension. 13 On the right side, a median sternotomy or partial median sternotomy with or without completing the "book" incision by opening into the fourth intercostal space may be used. The midportion of either subclavian artery is best approached via a supraclavicular incision.…”

Section: Discussionmentioning

confidence: 99%

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Subclavian Arterial Injury Associated with Blunt Trauma

Katras

Baltazar²,

Rush

et al. 2001

Vascular Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Subclavian Arterial Injury Associated with Blunt Trauma

Katras

Baltazar²,

Rush

et al. 2001

Vascular Surgery

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“…There is still some debate as to optimal exposure of the proximal left subclavian artery with some advocating a high antero-lateral thoracotomy combined with a clavicular incision[ 3 , 50 ]. Others, our group included, prefer to approach the proximal left subclavian using a sternotomy with extension if needed, as it provides excellent exposure[ 51 , 52 ]. Division of the innominate vein will greatly improve exposure.…”

Section: Introductionmentioning

confidence: 99%

Vascular injuries after blunt chest trauma: diagnosis and management

O’Connor¹,

Byrne

Scalea³

et al. 2009

Scand J Trauma Resusc Emerg Med

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“…Sternotomy (Figure 11) is the preferred access to the heart and great vessels. It is versatile as it can be extended as a laparotomy, periclavicular or neck incision [62,63]. Depending on the surgeon's experience lung resection can also be accomplished through this access.…”

Section: Surgical Exposurementioning

confidence: 99%

The Diagnosis and Treatment of Non-Cardiac Thoracic Trauma

O’Connor

Adamski

2010

J R Army Med Corps

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Penetrating and blunt force mechanisms frequently result in thoracic trauma. Thoracic injuries cover the spectrum from trivial to lethal, and more than half are associated with head, abdomen or extremity trauma. Fortunately over eighty percent of injuries can be managed non-operatively utilizing tube thoracostomy, appropriate analgesia and aggressive respiratory therapy. Patients requiring emergency thoracotomy are either in shock or have life threatening injuries and, as expected, have significant mortality and morbidity. Injury to the thorax directly accounts for approximately 25% of trauma related mortality and is a contributing factor in another 25%. Early mortality results from haemorrhage, catastrophic injury or associated head or abdominal trauma. Not unexpectedly, late deaths are related to sepsis and organ failure. Blunt injury to the thorax most commonly results from motor vehicle collisions, with motorcycle accidents, pedestrians struck and falls next in frequency. Stab wound and gunshot wounds comprise the vast majority of penetrating injuries. In general the mortality from penetrating injury is higher and related to vascular injury and shock. Mortality from blunt trauma often results from abdominal and, especially, head injury. Rapid assessment and interventions, such as tube thoracostomy and airway control, can be life saving. The patient's haemodynamic status drives early treatment, often necessitating emergency surgery. Detailed imaging studies are reserved for haemodynamically stable patients. The evaluation and treatment of specific thoracic injuries will be discussed, as well as some general principles in treating thoracic trauma.

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Surgical Exposure of the Left Subclavian Artery by Median Sternotomy and Left Superaclavicular Extension

Cited by 19 publications

References 9 publications

Subclavian Arterial Injury Associated with Blunt Trauma

Subclavian Arterial Injury Associated with Blunt Trauma

Vascular injuries after blunt chest trauma: diagnosis and management

The Diagnosis and Treatment of Non-Cardiac Thoracic Trauma

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