Management and Outcomes of Isolated Axillary Artery Injury: A Five-Year National Trauma Data Bank Analysis

Angus, L.D. George; Gerber, Noam; Munnangi, Swapna; Wallace, Raina; Singh, Shridevi; DiGiacomo, Jody C.

doi:10.1016/j.avsg.2019.10.085

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…When axillary artery injury is due to blunt force trauma, each patient should be evaluated independently for optimal treatment options based on risk factors, institutional expertise and severity of trauma. Angus et al [10] found that patients with blunt trauma to the axillary artery treated surgically had longer hospital stays and complication rates than those treated with surgery for penetrating traumas. In their study, Angus showed that axillary artery injury secondary to blunt trauma can have excellent outcomes with endovascular treatment [10] .…”

Section: Discussionmentioning

confidence: 99%

“…Angus et al [10] found that patients with blunt trauma to the axillary artery treated surgically had longer hospital stays and complication rates than those treated with surgery for penetrating traumas. In their study, Angus showed that axillary artery injury secondary to blunt trauma can have excellent outcomes with endovascular treatment [10] .…”

Section: Discussionmentioning

confidence: 99%

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Critical stenosis of axillary artery treated with percutaneous angioplasty and stenting: a case report and review of the literature

Kim

Youssef

2022

Radiology Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Critical stenosis of axillary artery treated with percutaneous angioplasty and stenting: a case report and review of the literature

Kim

Youssef

2022

Radiology Case Reports

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“…Cases of injuries to other abbreviated injury scale regions were also disregarded. [31][32][33][34][35] The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were followed in this study. Patients with PE, as defined by the International Classification of Disease and Procedure Coding System (ICD-10-PCS Code:0FBG0ZZ), were included in further analysis.…”

Section: Methodsmentioning

confidence: 99%

Injury characteristics and predictors of mortality in patients undergoing pancreatic excision after abdominal trauma: A National Trauma Data Bank (NTDB) study

Alzerwi

2023

Medicine

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Pancreatic tumors and pancreatitis are the main indications for pancreatic excision (PE). However, little is known about this type of intervention in the context of traumatic injuries. Surgical care for traumatic pancreatic injuries is challenging because of the location of the organ and the lack of information on trauma mechanisms, vital signs, hospital deposition characteristics, and associated injuries. This study examined the demographics, vital signs, associated injuries, clinical outcomes, and predictors of in-hospital mortality in patients with abdominal trauma who had undergone PE. Following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we analyzed the National Trauma Data Bank and identified patients who underwent PE for penetrating or blunt trauma after an abdominal injury. Patients with significant injuries in other regions (abbreviated injury scale score ≥ 2) were excluded. Of the 403 patients who underwent PE, 232 had penetrating trauma (PT), and 171 had blunt trauma (BT). The concomitant splenic injury was more prevalent in the BT group; however, the frequency of splenectomy was comparable between groups. In particular, concomitant kidney, small intestine, stomach, colon, and liver injuries were more common in the PT group (all P < .05). Most injuries were observed in the pancreatic body and tail regions. The trauma mechanisms also differed between the groups, with motor vehicles accounting for most of the injuries in the BT group and gunshots accounting for most of the injuries in the PT group. In the PT group, major liver lacerations were approximately 3 times more common (P < .001). The in-hospital mortality rate was 12.4%, with no major differences between the PT and BT groups. Furthermore, there was no difference between BT and PT with respect to the location of the injuries in the pancreas, with the pancreatic tail and body accounting for almost 65% of injuries. Systolic blood pressure, Glasgow Coma Scale score, age, and major liver laceration were revealed by logistic regression as independent predictors of mortality, although trauma mechanisms and intent were not linked to mortality risk.

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“…Traumatic axillary and subclavian artery injuries are uncommon and can be challenging to manage. 1,2 These injuries are associated with high mortality, with some historical studies reporting mortality as high as 34%. 3 Given the anatomic location of these injuries, it can be difficult to achieve hemorrhage control.…”

Section: Introductionmentioning

confidence: 99%

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

Boudreau,

Schucht,

Sigdel

et al. 2024

Vasc Endovascular Surg

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Objective Traumatic axillary and subclavian artery injuries are uncommon. Limited data are available regarding patient and injury characteristics, as well as management strategies and outcomes. Methods Retrospective chart review was performed on patients presenting to University of Louisville Hospital, an urban Level One Trauma Center, with traumatic axillary and subclavian artery injuries from 2015-2021. Patients were identified using University of Louisville trauma, radiology, and billing database searches based on ICD9/10 codes for axillary and subclavian artery injuries. Descriptive statistics are expressed as frequencies and percentages. Comparisons were performed using Fisher’s Exact and Chi-squared tests. Results Forty-four patients with traumatic axillary-subclavian arterial injuries were identified for analysis. Blunt and penetrating trauma were equally represented (n = 22 for both). A variety of injury types were seen, including minimal/intimal injury, laceration, pseudoaneurysm, transection, occlusion, and arteriovenous fistula. Management strategies were also variable, including non-operative, endovascular, planned hybrid, open, and endovascular converted to open. In operative patients, revascularization technical success was high (n = 31, 97%) with low likelihood of thrombosis (n = 2, 6%) and no infections. Among all patients, amputation rate was 5% (n = 2) and mortality rate was 9% (n = 3). Regarding arterial involvement, blunt injury was more likely to affect the subclavian (n = 18) than the axillary artery (n = 6) ( P = .04). No significant difference was seen in brachial plexus injury based on artery involved (subclavian = 9 vs axillary = 11, P = .14) or mechanism (blunt = 6 vs penetrating = 11, P = .22). Non-operative management was more likely with subclavian artery injury (n = 11) vs axillary artery injury (n = 1) ( P = .008). There was no significant difference between decision for non-operative (blunt = 9, penetrating = 3) vs operative (blunt = 13, penetrating = 19) management based on mechanism ( P = .09). Transection injury was associated with an open repair strategy (endovascular/hybrid = 1, open/endovascular to open conversion = 11, P = .0003). Of the three patients requiring endovascular to open conversion, two required amputation, which were the only two patients in the study undergoing amputation. Conclusions Both open and endovascular/hybrid strategies are useful when treating traumatic axillary and subclavian artery injuries and are associated with high likelihood of revascularization technical success, with low rates of thrombosis or infection, when treated promptly at a trauma center with vascular specialists available. Transection injuries were most often treated with open revascularization. Patients undergoing amputation had blunt transection injuries to the subclavian artery and underwent endovascular to open conversion after failed attempts at endovascular revascularization.

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Management and Outcomes of Isolated Axillary Artery Injury: A Five-Year National Trauma Data Bank Analysis

Cited by 7 publications

References 28 publications

Critical stenosis of axillary artery treated with percutaneous angioplasty and stenting: a case report and review of the literature

Critical stenosis of axillary artery treated with percutaneous angioplasty and stenting: a case report and review of the literature

Injury characteristics and predictors of mortality in patients undergoing pancreatic excision after abdominal trauma: A National Trauma Data Bank (NTDB) study

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

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