The clinical diagnosis of ruptured subclavian artery following blunt thoracic trauma

Sturm, James T.; Cicero, James J.

doi:10.1016/s0196-0644(83)80126-7

Cited by 24 publications

(7 citation statements)

References 6 publications

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“…The most frequent manifestation is a sign resulting from arterial occlusion, such as diminished or absent pulses in the upper limbs [12]. Sturm and Cicero described five criteria for suspected subclavian vascular injury, including fractures of the first rib, diminished or absent radial pulses, palpable supraclavicular hematoma, a widened mediastinum or a hematoma over the area of the subclavian artery demonstrated by chest roentgenograms and brachial plexus palsy [13]. Some studies reported, however, that only 20% of patients had “hard signs”, and a pulse deficit was found in only 32–59% of patients with TSVI [1, 6, 12].…”

Section: Discussionmentioning

confidence: 99%

Eighteen years’ experience of traumatic subclavian vascular injury in a tertiary referral trauma center

Kou

Liao

Huang

et al. 2019

Eur J Trauma Emerg Surg

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PurposeTraumatic subclavian vascular injury (TSVI) is rare but often fatal. The precise diagnosis of TSVI remains challenging mainly because of its occult nature, less typical presentations, and being overlooked in the presence of polytrauma. Compared to penetrating injuries, it is even more difficult to identify TSVI in patients who have blunt injuries and no visible bleeding. The risk factors associated with TSVI in patients with thoracic trauma are unclear. The aims of this study were to identify risk factors for TSVI in a cohort of patients with thoracic vascular injuries and to report outcomes after clinical treatment.MethodsFrom January 2009 to June 2017, 39586 patients were admitted to our hospital (a level I trauma center) due to trauma, and 136 patients with thoracic vascular injury were enrolled in this study. We retrospectively reviewed data from medical records including demographic characteristics, injury scoring systems (RTS, ISS, NISS, TRISS and AIS), management and outcomes. Patients were further divided into the TSVI group (patients with TSVI) and the non-TSVI group (patients with thoracic vascular injuries other than TSVI). Univariate and multivariate analyses were used to identify independent risk factors.ResultsThe enrolled 136 patients suffered mostly from blunt trauma (89.0%) and 22 of them had TSVI. When compared to the non-TSVI group, the TSVI group had lower Glasgow Coma Scale (GCS) scores (p = 0.002; especially GCS ≤ 12), less concurrent abdominal injury (p < 0.001), lower Injury Severity Scales (ISS) (p = 0.007) and New Injury Severity Scales (NISS) (p < 0.002) but had higher Abbreviated Injury Scales (AIS) of the head ≥ 3 (p = 0.009) and rates of clavicular or scapular fractures (p = 0.013). No difference was detected between the two groups with regard to age, gender, trauma mechanism, vital signs on arrival, or rate of facial and extremities injury. In multivariate regression analyses, GCS ≤ 12, AIS of the head ≥ 3 and the presence of clavicular or scapular fractures were independent risk factors for TSVI (p = 0.026, p = 0.043 and p = 0.005, respectively) after adjustment for confounding factors. Open and endovascular repair were two surgical procedures utilized for these TSVI patients with an overall mortality rate of 18.2%. No difference was found between these groups with regard to mortality rate and the length of ICU stay, but the patients in the TSVI group had a shorter length of hospital stay.ConclusionsOur results suggest that GCS ≤ 12, AIS of the head ≥ 3 and the presence of clavicular or scapular fractures were independent risk factors for TSVI in patients with thoracic vascular injuries. For patients with thoracic trauma, TSVI should be considered for prompt management when patients exhibit concurrent injuries to the head, clavicle or scapula.

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Section: Discussionmentioning

confidence: 99%

Eighteen years’ experience of traumatic subclavian vascular injury in a tertiary referral trauma center

Kou

Liao

Huang

et al. 2019

Eur J Trauma Emerg Surg

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“…In 1983 Sturm and Cicero devised five criteria that lead the examining doctor to suspect an arterial injury [ 7 ]. These criteria include first rib fracture, diminished or absent radial pulses, palpable supraclavicular hematoma, chest X-ray demonstrating a widening of the mediastinum or haematoma over the area of the subclavian artery, and brachial plexus palsy.…”

Section: Discussionmentioning

confidence: 99%

Subclavian Artery Pseudoaneurysm Formation 3 Months after a Game of Rugby Union

Evans

Roy

Rocker

2015

Case Reports in Emergency Medicine

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Pseudoaneurysms of the subclavian artery remain a rare complication after fracture of the clavicle. We report a case of delayed diagnosis of a subclavian artery pseudoaneurysm after a closed fracture of the clavicle in a 15-year-old patient, 3 months after the original injury while playing rugby union. Despite several attendances to the Emergency Department with vague symptoms, the final diagnosis was confirmed by duplex ultrasound and Computed Tomography of the thorax. Surgical repair was indicated due to acute limb ischaemia from distal embolisation from a large pseudoaneurysm, with the patient making a full recovery. This case highlights the need for clinical vigilance when assessing patients, particularly on repeated occasions when their recovery appears to be impaired. A thorough history and clinical examination can raise suspicion of even rare occurrences and aid prompt management.

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“…11,12 The subclavian artery is particularly protected by an important muscularskeletal-ligamentous apparatus formed by the subclavius muscle, the clavicle, the first rib, the deep cervical fascia and the costo-coracoid ligament. 13 For this reason, most blunt lesions of the subclavian artery resulting from downward forces applied to the thorax require involvement of great energies and are associated with important bone or soft tissue injuries in the majority of cases.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries

Oliveira

Rodrigues

Gonçalves

et al. 2014

Angiologia e Cirurgia Vascular

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Introduction: Blunt trauma of the axillary and subclavian arteries is uncommon. Conventional surgery presents significant morbidity associated to the need of extensive exposure and challenging dissection through traumatized tissues. Endovascular treatment is an alternative that has increasingly been used in traumatic arterial injuries. This report presents three cases that were managed by endovascular techniques. Methods: We report the cases of three patients with blunt traumatic injuries of the subclavian and axillary arteries who were treated at our Institution in 2013 with endovascular techniques. Each case presented distinctly, resulting from different traumatic mechanisms and the therapeutical approach was adapted accordingly. Results: Case 1: A 68-year-old man was admitted with an acute limb ischemia of the left upper limb after a fall from his own walking height. A computerized tomography angiography demonstrated a dissection of the left subclavian artery. Resource to a proximal angioplasty with stent allowed the recovery of the limb perfusion fixating the flap. Case 2: A 34-year-old male who fell from a height of 8 m, with multiple costal arch fractures and the complete transection of the subclavian artery. In this case, a covered stent excluded the rupture. Case 3: A 45-year-old woman presented to our department with an acutely ischemic left upper limb with 3 days of progression after a distension of the scapuloh-umeral articulation. Although a digital amputation was ultimately necessary, hand-salvage was accomplished through thrombectomy and catheter-directed thrombolysis. Conclusion: Blunt trauma of the axillosubclavian arteries is rare and its diagnosis may be challenging. Endovascular treatment of blunt traumatic injuries of the subclavian and axillary

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The clinical diagnosis of ruptured subclavian artery following blunt thoracic trauma

Cited by 24 publications

References 6 publications

Eighteen years’ experience of traumatic subclavian vascular injury in a tertiary referral trauma center

Eighteen years’ experience of traumatic subclavian vascular injury in a tertiary referral trauma center

Subclavian Artery Pseudoaneurysm Formation 3 Months after a Game of Rugby Union

Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries

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