Traumatic Subclavian Arterial Thrombosis Presenting with Cerebral Infarct – A Case Report

Chavali, Siddharth; Shukla, Urvi; Chauta, Samith

doi:10.1016/j.hlc.2014.04.254

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…There have been reports of patients who had delayed symptom recognition but were treated successfully in late phases 8 , 9 . However, there have been cases with massive hemorrhage due to transection of the subclavian artery 1 or cerebral infarction due to occlusion of the subclavian artery 2 within hours after injury, highlighting the importance of urgent therapeutic management of subclavian artery injury. Our case presented an intimal injury of the subclavian artery with a thrombus leading to upper extremity ischemia, which could cause retrograde thromboembolization and cerebral infarction.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Urgent endovascular treatment of subclavian artery injury after blunt trauma

et al. 2014

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Subclavian arterial injury is rare and potentially life-threatening, particularly when it leads to arterial occlusion, causing limb ischemia, retrograde thromboembolization and cerebral infarction within hours after injury. Here we report a blunt trauma case with subclavian arterial injury, upper extremity ischemia, and the need for urgent treatment to salvage the limb and prevent cerebral infarction. A 41-year-old man had a left, open, mid-shaft clavicle fracture and left subclavian artery injury accompanied by a weak pulse in the left radial artery, decreased blood pressure of the left arm compared to the right, and left hand numbness. Urgent debridement and irrigation of the open clavicle fracture was followed by angiography for the subclavian artery injury. The left distal subclavian artery had a segmental dissection with a thrombus. Urgent endovascular treatment using a self-expanding nitinol stent successfully restored the blood flow and blood pressure to the left upper extremity. Endovascular treatment is a viable option for cases of subclavian artery injury where there is a risk of extremity ischemia and cerebral infarction.

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Section: Discussionmentioning

confidence: 99%

“…Subclavian arterial injury caused by blunt trauma is rare with potentially high morbidity and mortality 1 , 2 . Open clavicle fractures caused by blunt trauma are also rare 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Case Report: Urgent endovascular treatment of subclavian artery injury after blunt trauma

et al. 2014

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“…Concerns over the deleterious effects of displaced medial clavicle fractures on other surrounding structures as well as the high nonunion rate (8–14%) and poor patient outcomes with nonoperative management have led some to favor surgical stabilization of these injuries [7,17,18,26]. Neurovascular complications that have been associated with medial clavicle fractures include pseudoaneurysm formation, subclavian arterial thrombosis and brachial plexus palsy [27–30]. In contrast to adults, our patients did not have any associated injuries and often sustained their fractures from direct impact during sporting incidents.…”

Section: Discussionmentioning

confidence: 97%

“…Neurovascular Fig. 3 The shape of the medial clavicle on CT scan shows the curve with anterior apex (*) complications that have been associated with medial clavicle fractures include pseudoaneurysm formation, subclavian arterial thrombosis and brachial plexus palsy [27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Medial clavicle shaft fractures in children and adolescents: differences from adults and management

Whyte

Veerkamp²,

Parikh³

2022

Journal of Pediatric Orthopaedics B

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Clavicle fractures are a common injury in the pediatric and adolescent population. Most fractures are located in the middle third of the clavicle. There has been no information in the literature regarding the management of extra-physeal medial clavicle shaft fractures in this population. The objective of this study is to evaluate demographic and injury characteristics, management options and clinical outcomes of medial clavicle fractures in children and adolescents and differentiate them from those in adults. A retrospective review was performed at a single institution to identify patients with medial clavicle shaft fractures. Radiographs, clinical features and patient-reported outcomes (QuickDASH) were analyzed. Eight patients were identified with medial clavicle fractures. Two fractures could not be diagnosed on anteroposterior radiographs. Both operative (four patients) and nonoperative (four patients) treatment had excellent radiographic and clinical outcomes, irrespective of initial displacement. Compared to high-energy and life-threatening injuries in adults, these fractures in children and adolescents were sports-related and isolated fractures. Conservative treatment should be considered for medial clavicle fractures in children and adolescents. These fractures are distinct from their adult counterparts and do not lead to increased morbidity or mortality.

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“…Although this case describes injury from a minimally displaced fracture, it is more common with a posterior bone shard which usually results from a high force injury such as with a motor vehicle accident 10. This sort of injury is more often associated with an isolated thrombus formation in the vessel rather than a rupture, dissection or pseudoaneurysm,11 and although delayed presentations have been treated successfully in late phases,12 13 documented cases of massive haemorrhage with fatality due to rupture of the SA14 or acute cerebral infarction due to retrograde thromboembolisation15 highlight the importance of urgent therapeutic management of SA injury.…”

Section: Discussionmentioning

confidence: 99%

Acute subclavian artery occlusion with associated clavicle fracture managed with bypass graft alone

Buchanan¹,

Owen

Angliss

et al. 2018

BMJ Case Reports

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Subclavian artery injury is a rare consequence of clavicle fracture. It most often results from penetrating trauma but can result from blunt trauma with adjacent bone fragments causing rupture, pseudoaneurysm, dissection or thrombosis of the artery. If flow through the subclavian artery is compromised there is a risk of ipsilateral upper limb ischaemia. Life-threatening haemorrhage may result in cases of laceration, and cerebral infarction may result from dissection. Vascular injury in association with clavicle fracture is typically regarded as an indication for internal fixation of the fracture. We present a case of subclavian artery thrombosis in association with a comminuted midshaft clavicle fracture causing limb ischaemia managed by carotid to brachial artery bypass without internal fracture fixation. The fracture united at 4 weeks and there was no sustained vascular or neurological impairment at follow-up. We advocate urgent vascular intervention in subclavian artery injury. There is little discussion in the literature regarding non-operative management of clavicle fractures with subclavian artery injury. We suggest that select clavicle fractures with subclavian artery injury can be safely managed non-operatively.

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Traumatic Subclavian Arterial Thrombosis Presenting with Cerebral Infarct – A Case Report

Cited by 8 publications

References 5 publications

Case Report: Urgent endovascular treatment of subclavian artery injury after blunt trauma

Case Report: Urgent endovascular treatment of subclavian artery injury after blunt trauma

Medial clavicle shaft fractures in children and adolescents: differences from adults and management

Acute subclavian artery occlusion with associated clavicle fracture managed with bypass graft alone

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