Successful management with endovascular stent graft repair following gunshot wound to the subclavian artery: Case report and literature review

Elkbuli, Adel; Shaikh, Saamia; McKenney, Mark; Boneva, Dessy

doi:10.1016/j.ijscr.2019.09.040

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…Recently, endovascular techniques have been safely utilized in the treatment of patients with vascular injuries at various sites. 13 , 14 A few case reports demonstrated endovascular treatment using stent grafts for axillary artery injuries in patients with humerus fractures 11 and glenohumeral dislocation. 10 In our case, endovascular treatment of the axillary artery injury via only the right femoral artery approach was impossible.…”

Section: Discussionmentioning

confidence: 99%

Bidirectional endovascular treatment for axillary artery injury secondary to proximal humerus fracture: a case report

Kanda

Imagama

Imoto

et al. 2021

European Heart Journal - Case Reports

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Background Axillary artery injury secondary to proximal humerus fracture is a rare but serious complication. The management of this injury has traditionally involved surgical treatment. Case summary A 66-year-old female with gait disturbance slipped and fell off her wheelchair at home. She presented to a local hospital with right shoulder pain and was subsequently urgently transferred to our hospital by helicopter because of suspicion of axillary artery injury. Computed tomography angiography revealed disruption of the right axillary artery. We decided to perform endovascular treatment instead of surgical treatment for axillary artery injury. However, since endovascular treatment via the right femoral artery was impossible, we performed bidirectional (right femoral and right brachial artery approaches) endovascular treatment. We expanded the occluded lesion using a 3.5 mm × 40 mm sized balloon and placed a 5.0 mm × 50 mm stent graft (Gore® Viabahn®) across the lesion. The final subclavian injection confirmed that distal flow to the brachial artery was preserved and that there was no leakage of contrast medium from the axillary artery. Discussion We performed endovascular treatment for axillary artery injury secondary to proximal humerus fracture. Although surgical repair is typically performed for this kind of injury, our experience suggests that endovascular treatment might be an option in patients with axillary artery injury.

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Section: Discussionmentioning

confidence: 99%

Bidirectional endovascular treatment for axillary artery injury secondary to proximal humerus fracture: a case report

Kanda

Imagama

Imoto

et al. 2021

European Heart Journal - Case Reports

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“…Injuries to the subclavian and axillary arteries account for 5% to 10% of vascular injuries in civilian trauma centers, mostly from penetrating trauma. 2 3 The subclavian artery is located in the transition zone between the thorax, neck, and upper extremity, and, as such, it is protected by the thoracic outlet comprised of the clavicle, first rib, subclavius muscle, deep cervical fascia, costocoracoid ligament, and clavi-coraco-axillary fascia. Because of this protection, stab injuries do not lead to injury as commonly as gunshot wounds.…”

Section: Discussionmentioning

confidence: 99%

“… 1 2 The most common associated injuries include those to the subclavian vein, vertebral artery, carotid artery, brachial plexus, aerodigestive tract in the neck, lung, spinal cord, and sympathetic nerve chain. 2 3 In the modern era, deaths are usually due to associated injuries. 4…”

Section: Discussionmentioning

confidence: 99%

“…Another is that the injured vessel and the surrounding damaged structures cannot be visualized. 2 Postoperative complications include stent thrombosis and migration, endoleaks, access site injuries, and embolic events. Overall, because subclavian artery injuries are so uncommon, there is a paucity of data on the long-term outcomes of endovascular repair.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular stent-graft repair of transected left subclavian artery

Jinadasa

Hall

Feliciano

2021

Trauma Surg Acute Care Open

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“…Prophylactic consultation and involvement of the endovascular and/or interventional radiology team is recommended in cases of complex and sever mandibular fractures, particularly those with proximity to a vascular structure that could be potentially injured due to excessive dissection/manipulation. Over the last decade, minimally invasive procedures, including ultrasound guided compression and thrombin injection, coil and glue embolization, and endovascular repairs of vascular injuries have been augmenting or even replacing open procedures due to its improved outcomes and prognoses [ [15] , [16] , [17] ].…”

Section: Discussionmentioning

confidence: 99%

A rare case of large left internal maxillary artery pseudoaneurysm secondary to mandibular fracture: A case report and review of the literature

Cogollo

Elkbuli

McKenney

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Pseudoaneurysms secondary to traumatic vessel wall disruption are a rare but potentially fatal complication after traumatic injury. The majority of the cases are found incidentally. Case presentation An 80-year-old woman was brought into our Level 1 Trauma Center after sustaining a ground-level fall with significant facial swelling. Her imaging revealed an acute traumatic comminuted fracture of the right mandibular condyle and left mandibular ramus. The patient underwent closed maxillomandibular fixation (MMF) to stabilize fractures, and allow the swelling to decrease for definitive fixation. During the definitive procedure, profuse bleeding was encountered. CT angiography evaluation was immediately performed and determined the presence of a left internal maxillary artery pseudoaneurysm which was successfully treated by coil and glue embolization. Clinical discussion This case highlights an unusual presentation of a vascular injury following major traumatic mandibular fracture and its management. Mandibular fractures have been reported in a series of cases to be a risk factor for vascular injuries. When a vascular injury is suspected, or the evaluation is unclear, surgeons should carefully determine the necessity to perform additional studies like CT angiogram. Vascular injuries secondary to mandibular fractures can be fatal if left unrecognized and untreated. Hence adequate recognition and treatment are warranted to avoid prolonged length of stay with bad outcomes. Conclusion Optimal management of pseudoaneurysms is achieved by endovascular approach with prior resuscitation and adequate hemodynamic stabilization. Open surgical management is deferred only for those cases where endovascular treatment is not available, or disruption is found intraoperatively.

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Successful management with endovascular stent graft repair following gunshot wound to the subclavian artery: Case report and literature review

Cited by 9 publications

References 20 publications

Bidirectional endovascular treatment for axillary artery injury secondary to proximal humerus fracture: a case report

Bidirectional endovascular treatment for axillary artery injury secondary to proximal humerus fracture: a case report

Endovascular stent-graft repair of transected left subclavian artery

A rare case of large left internal maxillary artery pseudoaneurysm secondary to mandibular fracture: A case report and review of the literature

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