Tratamento endovascular de fístula traumática de vasos subclávios: relato de caso

Maués, José Júlio Bechir; Hauter, Heather Lynn

doi:10.1590/1677-5449.010317

Cited by 5 publications

(8 citation statements)

References 10 publications

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“…Long injuries with no proximal neck for fixation, large discrepancy in diameters of the injured vessel, impossibility of catheterization, compressive symptoms, aerodigestive tract trauma, and infected lesions are all contraindications to endovascular repair. These factors were also considered for the case reported herein [ 2 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The cavitation process caused by the projectile can also be responsible for the damage of adjacent tissues and vessels, promoting inflammation, angiogenesis and delaying the resolution of arteriovenous fistulas. Prompt treatment is recommended to prevent these complications [ 4 , 5 ]. The patient in this report developed an arteriovenous fistula involving the internal jugular vein and the subclavian artery and its branches, after failure to diagnose trauma to the subclavian artery.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular treatment of subclavian artery injury with a complex post-traumatic fistula: Case report

Pessoa¹,

Araújo²,

Caron³

et al. 2021

Trauma Case Reports

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Background Endovascular treatment in trauma is a promising strategy to reduce perioperative morbidity and mortality. We report the case of a gunshot wound causing an initially undiagnosed subclavian artery injury, with delayed progression to a complex, difficult-to-manage arteriovenous (AV) fistula. Placement of an encapsulated endovascular stent graft resolved the primary lesion, but persistent cervical arteriovenous communications were only repaired after multiple, sequential embolization procedures. Report A 25-year-old male sustained a gunshot wound to the right neck. Initial treatment failed to identify any vascular injury, and the patient was discharged. Three weeks later, he presented to our facility with headache and a palpable right-sided cervical thrill. Arteriography showed contrast extravasation from the right subclavian artery and an AV fistula with the ipsilateral internal jugular vein. The arterial injury was repaired with an encapsulated stent graft, but residual contrast leak persisted on follow-up angiography. Three months after the first intervention, cervical thrill was still present; a right vertebral–right internal jugular AV fistula was identified and repaired by distal coil embolization. One month later, persistent symptoms prompted repeat arteriography, which again identified contrast extravasation, now involving the thyrocervical trunk. Selective thyrocervical embolization was ultimately successful, with resolution of symptoms and no further evidence of contrast leak. Conclusion Delayed management of neck trauma can be challenging due to neovascularization, which hinders open repair in this delicate region. Post-traumatic arteriovenous fistulas are thus a particularly fearsome complication, and can be very difficult to approach; as in our patient, multiple interventions may be required. This case highlights the importance of detecting vascular trauma as early as possible, as a delay in diagnosis can hinder treatment and eventuate challenging late complications. Further studies are needed to demonstrate the long-term benefits of endovascular management of complex vascular injuries of the neck region.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of subclavian artery injury with a complex post-traumatic fistula: Case report

Pessoa¹,

Araújo²,

Caron³

et al. 2021

Trauma Case Reports

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“…Lesões vasculares cérvico-torácicas são raras e, em até 90% dos casos, causadas por ferimentos penetrantes, com acometimento de vasos subclávios em 2 a 4% desses traumatismos 1,4,10 .…”

Section: Discussionunclassified

“…Traumas penetrantes de vasos subclávios atingem mortalidade de até 60% no cenário pré-hospitalar, tornando a rapidez de acesso ao centro de trauma um fator decisivo. A mortalidade intraoperatória varia de 5-30% [1][2][3][4] .…”

Section: Introductionunclassified

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Controle de danos para lesão de artéria subclávia

2020

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Resumo Os traumas penetrantes de vasos subclávios atingem mortalidade de até 60% em um cenário pré-hospitalar. A mortalidade no intraoperatório varia de 5-30%. Apresenta-se um caso de estratégia de controle de danos para um paciente com lesão na origem da artéria subclávia esquerda, através de ligadura, sem necessidade de outra intervenção, mantendo a viabilidade do membro superior esquerdo por meio de circulação colateral. Os autores fazem uma revisão sobre vias de acesso e estratégias de tratamento com ênfase em controle de danos para lesões de vasos subclávios.

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