Traumatic Injuries to the Subclavian and Axillary Arteries: A 13-Year Review

Abstract

Successful management of subclavian and axillary artery injuries requires prompt diagnosis because the occult nature of these injuries necessitates a high index of suspicion. Although revascularization procedures are often successful, it is the associated neurological, orthopedic, and soft tissue injuries that affect the functional outcome of the limb.

Associated Venous Injury Significantly Complicates Presentation, Management, and Outcomes of Axillosubclavian Arterial Trauma

“…There was no significant difference in mortality between the two groups (24% blunt vs. 19% penetrating). 8 Similar to the 13-year study by Aksoy et al, 7 one-third of our study group was blunt ASVI (33%).…”

“…1 Blunt ASVI ranges from 4 to 33% of traumatic ASVI. 4,7 Cox et al specifically compared blunt versus penetrating subclavian artery injury in their 13-year review study. Of 56 patients who sustained subclavian artery injuries, 25 patients (45%) had blunt injuries while 31 patients (55%) had penetrating injuries.…”

Operative exposure and management of axillary vessel injuries

“…Amputation rates for axillary artery injuries in recent civilian series have ranged from 0 to 3% [1,19,28], which is much lower than the 8.5-43.2% incidence reported during early military experiences [4,6]. Associated brachial plexus injury remains the major determinant of long-term functional outcome.…”

“…Thrombosis after arterial repair has been reported to range from 1.5 to 10%, while infectious complications have been reported to range from 0 to 21%. The mortality rates in recent civilian series have ranged from 3 to 14.8% [1,19,[27][28][29] (see Table 3). …”

Vias de acesso aos grandes vasos mediastinais no trauma torácico

“…rados com a técnica convencional, apresentam maior beneficio quanto à menor perda sanguínea; tempo reduzido do ato operatório; menor dissecção de estruturas anatômicas como plexo braquial, nervos frênico, laringeo recorrente, vago e veias braquiocefálicas com diminuição das taxas de lesões iatrogênicas 49,50,51 . Porém complicações relacionadas a este tipo de abordagem operatória ao traumatismo dos troncos braquiocefálicos são relatados em diversas séries 47,49,50,51 .Trombose, estenose, fratura e deslocamento do stent recoberto; oclusão inadvertida da artéria vertebral, bem como embolização cerebral e lesões concomitantes da artéria e veia subclávia por manipulação do fio guia estão entre as mais graves destas situações 52 .…”