Overcoming challenges of endovascular treatment of complex subclavian and axillary artery injuries in hypotensive patients

Gilani, Ramyar; Tsai, Peter I.; Wall, Matthew J.; Mattox, Kenneth L.

doi:10.1097/ta.0b013e318265cdec

Cited by 29 publications

(23 citation statements)

References 8 publications

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“…Successful endovascular approaches for arterial injuries using covered stents for Zone I injuries have been documented, although primarily as case reports and small series. 26,41 When endovascular techniques are not indicated, are unavailable, or are unsuccessful, standard open surgical techniques using proximal and distal vascular control is required for arterial/venous injuries. Hemodynamically stable patients with documented Zone I aerodigestive injury by CTA should undergo prompt operative intervention in most cases because this is associated with better outcome.…”

Section: Annotated Text For the Algorithmmentioning

confidence: 99%

Western Trauma Association Critical Decisions in Trauma

Sperry

Moore

Coimbra

et al. 2013

Journal of Trauma and Acute Care Surgery

165

114

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T his is a recommended algorithm of the Western Trauma Association for the management of penetrating neck trauma that has penetrated the platysma muscle of the neck. Because of the paucity of recent prospective randomized trials on the evaluation and management of penetrating neck injury, the current algorithm and recommendations are based on available published prospective cohort, observational, and retrospective studies and the expert opinion of the Western Trauma Association members. The algorithm (Fig. 1.) and accompanying text represents a safe and reasonable approach to this difficult injury type and attempts to incorporate the advent of recent advances in radiographic screening and selective or expectant management practice. We recognize that there will be variability in decision making, local resources, institutional consensus, and patient-specific factors that may require deviation from the algorithm presented. This annotated algorithm is meant to serve as a basis from which protocols at individual institutions can be developed or serve as a quick bedside reference for clinicians. The algorithm contains letters A through J, which correspond to the lettered text. Their purpose is to succinctly navigate the reader thru the algorithm and discuss those points, which require further elucidation or where data are lacking. 1Y3

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Section: Annotated Text For the Algorithmmentioning

confidence: 99%

Western Trauma Association Critical Decisions in Trauma

Sperry

Moore

Coimbra

et al. 2013

Journal of Trauma and Acute Care Surgery

165

114

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“…Limited comparisons between stent graft and open repairs show less blood loss, shorter operating times and fewer brachial plexus injuries in favour of stent grafts. [12][13][14] The reported early technical failure rates with surgery appear to be similar (~5%). [11] It is reassuring that the early and late conversion rates to open surgery remains consistently negligible in patients treated with stent grafts.…”

Section: Discussionmentioning

confidence: 77%

Stent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience

Naidoo

Beningfield

et al. 2015

S Afr J Surg

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Despite the paucity of long-term, durable data, stent graft repair has emerged as a safe and feasible alternative to open repair of trauma-related subclavian and axillary vascular injuries (SAVIs). Surgical treatment is often attended by high morbidity and mortality rates (5-30%). [1,2] Indeed, some have suggested that stent graft repair should be considered as first-line treatment for trauma-related SAVIs. Peripheral stent grafting evolved as a complementary treatment strategy since 2008 at Groote Schuur Hospital, Cape Town, for select patients with vascular trauma. Methods All patients considered endosuitable were counselled about the procedure, and the need for diligent follow-up was emphasised. Consent was obtained from all patients. The procedure was performed either in an interventional angio suite under local anaesthesia or in the operating theatre (OR) under general anaesthesia. Estimation of stent graft diameter and length was obtained from preoperative imaging modalities that included catheter angiography, duplex ultrasound (DUS) or computed tomography angiography (CTA). A range of stent grafts of different diameters and lengths was available at the time of the procedure. Access for deployment was obtained via percutaneous or 'cut-down' (femoral or brachial) approaches. When using femoral access, long systems were utilised (guidewires; balloon and stent catheters; long, appropriately sized sheaths). Heparin was given prior to lesion crossing and stent graft deployment in all cases. We maintained the habit of balloon moulding, a requirement for some older-generation

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“…In the late postoperative phase, in-stent restenosis, late endoleaks, stent migration, and other structural abnormalities can also occur. [21][22][23][24][25] Among the series available for review in the literature, much less is known about the potential ramifications of branch vessel coverage, especially with subclavian stents. There remains a potential risk that coverage of the origin of the vertebral artery can lead to basilar artery thrombosis with subsequent stroke.…”

Section: Discussionmentioning

confidence: 99%