Endovascular Repair of Transected Axillary Artery via Snare Assisted Through and Through Femoral to Brachial Artery Access

Abstract

Axillary artery injury is a rare but complex surgical problem that often requires challenging exposures, lengthy operations, and morbid outcomes for repair. For these reasons, endovascular repair is an attractive alternative as it obviates many of the challenges present with open repair. While pseudoaneurysms, dissections, and short segment injuries with limited arterial disruption are regularly treated endovascularly, complete arterial transections are almost exclusively treated with open repair as obtaining wire access across the site of injury is often not possible. Here we report a case of successful endovascular repair of a completely transected axillary artery with the use of snare assistance to obtain through and through femoral to brachial artery access. This ultimately allowed for covered stent deployment across the axillary transection restoring distal blood flow. Snare assistance in obtaining through and through access across areas of complete transection can allow for increased use of endovascular repair.

Contemporary Review of Traumatic Axillary and Subclavian Artery Injuries at an Urban Level One Trauma Center

“…Transection injuries were significantly associated with an open repair strategy in our study. While endovascular approaches to repair of transection injuries have been described, 14 generally involving introducing an endovascular snare from one end of the transected artery and snaring a wire from the other end of the transected artery in the intervening hematoma cavity, caution may be warranted as the only two patients requiring amputation in our study both had transection injuries and underwent open conversion after failed endovascular attempts at management. Given the variety of patient and clinical factors, as well as injury types/grades, multiple management strategies are possible.…”