An Analysis of 50 Surgically Managed Penetrating Subclavian Artery Injuries

Abstract

Objective: To evaluate the usefulness of systematic coronary angiography followed, if needed, by coronary artery angioplasty (percutaneous coronary intervention (PCI)) on the incidence of cardiac ischaemic events after carotid endarterectomy (CEA) in patients without evidence of coronary artery disease (CAD).Materials and methods: From January 2005 to December 2008, 426 patients, candidates for CEA, with no history of CAD and with normal cardiac ultrasound and electrocardiography (ECG), were randomised into two groups. In group A (n ϭ 216) all the patients had coronary angiography performed before CEA. In group B, all the patients had CEA without previous coronary angiography. In group A, 66 patients presenting significant coronary artery lesions at angiography received PCI before CEA. They subsequently underwent surgery under aspirin (100 mg day Ϫ1) and clopidogrel (75 mg day Ϫ1). CEA was performed within a median delay of 4 days after PCI (range: 1-8 days).Risk factors, indications for CEA and surgical techniques were comparable in both groups (p Ͼ 0.05). The primary combined endpoint of the study was the incidence of postoperative myocardial ischaemic events combined with the incidence of complications of coronary angiography. Secondary endpoints were death and stroke rates after CEA and incidence of cervical haematoma.Results: Postoperative mortality was 0% in group A and 0.9% in group B (p ϭ 0.24). One postoperative stroke (0.5%) occurred in group A, and two (0.9%) in group B (p ϭ 0.62). No postoperative myocardial event was observed in group A, whereas nine ischaemic events were observed in group B, including one fatal myocardial infarction (p ϭ 0.01). Binary logistic regression analysis demonstrated that preoperative coronary angiography was the only independent variable that predicted the occurrence of postoperative coronary ischaemia after CEA. The odds ratio for coronary angiography (group A) indicated that when holding all other variables constant, a patient having preoperative coronary angiography before carotid surgery was 4 times less likely to have a cardiac ischaemic event after carotid surgery. No complications related to coronary angiography were observed and no cervical haematomas occurred in patients undergoing surgery under aspirin and clopidogrel in this study.Conclusions: Systematic preoperative coronary angiography, possibly followed by PCI, significantly reduces the incidence of postoperative myocardial events after CEA in patients without clinical evidence of CAD. Aims: Older patients with spells of syncope may suffer from a carotid sinus syndrome (CSS). Patients with invalidating CSS routinely receive pacemaker treatment. This study evaluated the safety and early outcome of a surgical technique termed carotid denervation by adventitial stripping for CSS treatment. Clinical Results of Carotid Denervation by Adventitial Stripping inMethods: Carotid sinus massage (CSM) during cardiovascular monitoring confirmed CSS in patients with a history of repeated syncope and dizziness. The internal...

Associated Venous Injury Significantly Complicates Presentation, Management, and Outcomes of Axillosubclavian Arterial Trauma

“…4 Sobnach et al reviewed 50 patients who underwent surgical repair of subclavian artery injury, of which 24% had concomitant venous injury. 5 Our review of a larger multicenter trauma database showed a lower combined arterial and venous ASVI of 16%, which is more comparable to the experience of Demetriades and Asensio (20%). 1 It has been shown that venous injury portends a greater mortality risk than isolated arterial injury.…”

“…Combined injuries did not lead to differences in complications or most outcomes, with the exception once again being death. Blunt combined injuries had a statistically significant increase in 5). Penetrating injury also carried a higher mortality risk than blunt injury (OR, 1.96; CI, 1.03 to 3.73; p ¼ 0.041).…”

Endovascular Therapy of Vascular Trauma—Current Options and Review of the Literature

“…52 Concern for brachial injury if washout is not performed may not bear out-in one study where all 8 patients were managed with stents despite hemodynamic instability or hematoma, only 1 required a washout. 52 Lesions treated within the literature include occlusions, 54 dissections, 48,52,[55][56][57] pseudoaneurysm, 48,58,59 and arteriovenous (AV) fistulas 49,60 due to trauma. There are multiple reports of trauma secondary to iatrogenesis as well, which can present as AV fistulas and pseudoaneurysms.…”

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

“…17,18 Vascular repair may require extensive paraclavicular incisions for control; dissection though hematoma-distorted planes is feasible but not without a significant risk of neurovascular injury and significant hemorrhage. 21 In comparison, endovascular treatment is a safe and attractive alternative to conventional surgery in trauma patients.…”