Delayed subclavian artery rupture secondary to a traumatic first rib fracture

Tennyson, Charlene; Karunaratne, Devinda; McLaughlin, Kevin; Hasan, Ragheb; Grant, Stuart W

doi:10.1016/j.tcr.2018.07.001

Cited by 7 publications

(4 citation statements)

References 5 publications

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“…10 MS has also been successfully used to expose the left subclavian artery, which provides a wide operative field, and allows rapid vascular control. 9 In our cases, the classic «Trap-door» thoracotomy surgical technique was used, which has been associated with a higher incidence of severe postoperative bleeding and respiratory complications. 3,11 The unilateral anterior cervical-sternothoracotomy incision or «Trap-door» incision was first described as a route of exposure for Pancoast tumors of the superior sulcus.…”

Section: Discussionmentioning

confidence: 99%

“…Computed tomography angiography provides the best diagnostic information to identify subclavian vascular injuries. 9 The choice of surgical approach and incision type is one of the essential points to maintaining the patient's hemostasis; this depends on the injured side and the location of arterial and venous interruption. For some authors, the standard approach for left-sided trauma is anterolateral thoracotomy with a posterior supraclavicular or infraclavicular incision, while right-sided injuries are generally treated with an MS with supraclavicular extension.…”

Section: Discussionmentioning

confidence: 99%

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Toracotomía Trap-door como vía de acceso ideal para masaje cardiaco interno y reparación de vasos subclavios

Valdés-Dupeyrón,

Alvia-del Castillo,

Espinales-Casanova

et al. 2023

Cardiovasc Metab Sci

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Introducción: el traumatismo de vasos subclavios no es frecuente. Pueden presentarse en forma de hemorragia, hematoma en cuello y tórax superior, signos de hipoperfusión distal y choque. La toracotomía Trap-door permite una exposición amplia de la cavidad torácica y base del cuello que proporciona un acceso rápido a corazón, vasos subclavios, íleo pulmonar y demás estructura del mediastino anterior. Objetivo: describir la toracotomía de Trap-door como vía de acceso ideal para masaje cardiaco interno y reparación de vasos subclavios en pacientes graves. Presentación de casos: se presentan dos pacientes con lesiones severas de arterias subclavias que fueron intervenidos de forma emergente mediante toracotomía Trap-door, donde se realizó derivación de aorta ascendente a arteria axilar izquierdas con prótesis de politetrafluoroetileno en el primer caso y derivación de arteria carótida izquierda a arteria subclavia izquierdas con vena safena invertida en el segundo paciente. Conclusión: la toracotomía Trap-door permite el acceso óptimo de vasos subclavios y corazón en caso de necesitar realizar reanimación cardiopulmonar en pacientes graves.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Toracotomía Trap-door como vía de acceso ideal para masaje cardiaco interno y reparación de vasos subclavios

Valdés-Dupeyrón,

Alvia-del Castillo,

Espinales-Casanova

et al. 2023

Cardiovasc Metab Sci

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“…Some reports have also described open thoracotomy. Tennyson et al [2] reported traumatic subclavian artery rupture that was successfully repaired by thoracotomy and direct suturing. However, we considered that it would be difficult to perform open thoracotomy in our patient because the bleeding point was unclear.…”

Section: Discussionmentioning

confidence: 99%

Atraumatic bleeding of the subclavian artery 20 years after surgical treatment of pneumothorax

Miura

Kobayashi

2020

J Cardiothorac Surg

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Background: Bleeding of the subclavian artery is a fatal condition. Adhesion between the pleura and staple line may develop after surgical treatment of pneumothorax, and collateral arteries often develop from the subclavian artery toward the adhesion at the lung apex; however, atraumatic tearing and bleeding of these collateral arteries into the extrapleural and intrathoracic cavities is rare. Case presentation: A 70-year-old man visited the hospital for evaluation of left chest pain. Contrast-enhanced chest computed tomography showed a huge tumor in the left apex of the lung. It was suspected to be an extrapleural huge hematoma, and it ruptured into the thoracic cavity. Bleeding from the left subclavian artery was suspected; therefore, emergency angiography was performed. Angiography showed some collateral circulation from the left subclavian artery to the apex of the left lung. Distal and proximal bleeding points were identified. The distal bleeding point was embolized using coils. The proximal bleeding point was blown out, and stents were placed in the left subclavian artery. He had undergone pneumothorax surgery 20 years previously, and the present bleeding episode was strongly suspected to be associated with that surgery. The collateral circulation from the subclavian artery could have developed because of post-pneumothorax inflammation, eventually rupturing and bleeding into the extrapleural space. Conclusions: This report described an important case of atraumatic subclavian artery bleeding considered to have been caused by surgical treatment of pneumothorax 20 years previously. Emergency angiography and percutaneous stent placement or coil embolization should be considered first in such cases.

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“…第1肋骨骨折端により鎖骨下動脈損傷を遅発性に生じた報告は2例あり，いずれも受傷から34～35時間で致死的な大量血胸を生じていた 4), 5)。本症例のように，受傷から36時間以上経過した後に鎖骨下動脈損傷を生じた例は，文献検索した範囲で認められなかった。頻度は稀であるが，遅発性に重篤な病態を示すことがあり，注意深く経過観察する必要がある。…”

Section: 考　　察unclassified

第1肋骨骨折端により生じた遅発性鎖骨下動脈損傷に対して，血管内治療と骨折端摘除を併用した1例(Endovascular therapy and fractured–rib resection for delayed subclavian artery injury caused by a first rib fracture: a case report)

亮介¹,

彰太²,

博³

et al. 2021

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨　肋骨骨折は血管損傷をしばしば合併しうる。肋骨骨折により生じた鎖骨下動脈損傷に関して，確立された治療方針はない。63歳の男性が乗用車に衝突され受傷し，当院へ救急搬送された。Computed tomography（CT）で右第1肋骨骨折を含む両側多発肋骨骨折を認めた。第12病日，呼吸困難と血圧低下が突然生じた。造影CTで右鎖骨下動脈仮性瘤・右血胸を認め，第1肋骨骨折端により生じた鎖骨下動脈損傷と診断した。ステントグラフト留置により鎖骨下動脈損傷を修復した後，第1肋骨骨折端を摘除した。退院から1年経過した時点で，ステントグラフトの閉塞や，右肩関節の可動域制限を認めていない。第1肋骨骨折端が鎖骨下動脈近傍にある場合，鎖骨下動脈損傷を遅発性に起こす可能性がある。第1肋骨骨折端による鎖骨下動脈損傷に対して，血管内治療と骨折端摘除の併用療法は有用である。

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Delayed subclavian artery rupture secondary to a traumatic first rib fracture

Cited by 7 publications

References 5 publications

Toracotomía Trap-door como vía de acceso ideal para masaje cardiaco interno y reparación de vasos subclavios

Toracotomía Trap-door como vía de acceso ideal para masaje cardiaco interno y reparación de vasos subclavios

Atraumatic bleeding of the subclavian artery 20 years after surgical treatment of pneumothorax

第1肋骨骨折端により生じた遅発性鎖骨下動脈損傷に対して，血管内治療と骨折端摘除を併用した1例(Endovascular therapy and fractured–rib resection for delayed subclavian artery injury caused by a first rib fracture: a case report)

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