Uncertain Patency of Covered Stents Placed for Traumatic Axillosubclavian Artery Injury

Objective: To review the current use of endovascular techniques in trauma. Summary Background Data: Multiple studies have demonstrated that, despite current guidelines, endovascular therapies are used in instances of arterial trauma. Methods: The existing literature concerning arterial trauma was reviewed. Studies reviewed included case reports, single-center case series, large database studies, official industry publications and instructions for use, and society guidelines. Results: Endovascular therapies are used in arterial trauma in all systems. The use of thoracic endografts in blunt thoracic aortic trauma is accepted and endorsed by society guidelines. The use of endovascular therapies in other anatomic locations is largely limited to single-center studies. Advantages potentially include less morbidity due to smaller incisions as well as shorter operating room times. Many report using endovascular therapies even with hard signs of injury. Long-term results are limited by a lack of long-term follow-up but, in general, suggest that these techniques produce acceptable outcomes. The adoption of these techniques may be limited by resource and surgeon availability. Conclusions: The use of endovascular therapies in trauma has gained acceptance despite not yet having a place in official guidelines.

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“…A single-center study found that only 70% of these patients are compliant with antiplatelet agents. 55…”

Section: Upper Extremitymentioning

confidence: 99%

“…Patency is a difficult question to answer; a mixed study of popliteal, subclavian, SFA, and iliac stents showed a median patency of 68% at 93 days. 110 Loss to follow-up in these studies can be as high as 70%, 55 making patency difficult to assess.…”

Section: Other Considerationsmentioning

confidence: 99%

Endovascular Therapy of Vascular Trauma—Current Options and Review of the Literature

Glaser

Kalapatapu

2019

Vasc Endovascular Surg

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“…6 Unfortunately, for both adult and pediatric populations, long-term follow-up for these interventions is lacking, with variable outcomes reported in the literature. 5,7 Current adult endovascular techniques and devices are too large to accommodate pediatric vessels, which are more prone to iatrogenic dissection, spasm, and thrombosis. This is likely why the mean age of the endovascular cohort in our population was significantly higher than that of our open cohort, as the older children were more likely to have arteries closer to adult size.…”

Section: Discussionmentioning

confidence: 99%

“…Other potential benefits include the avoidance of intracavitary surgery-associated complications, no need for aortic cross-clamping or extracorporeal bypass, and lower transfusion requirements. [1][2][3][4][5][6][7] Overall, there were significant differences in demographics and clinical data between the two cohorts that required data adjustments using logistic regression analysis to account for potential confounders. Endovascular patients were older, were more likely to have sustained blunt trauma, and had higher ISS.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the reports lack long-term follow-up, with variable rates of patency of endovascular interventions. Regardless of unclear longterm efficacy, reported rates of endovascular therapy in adult arterial trauma appear to be increasing, [5][6][7] with early survival benefits noted with endovascular therapy. 6 Although uncommon among children, traumatic arterial injuries remain a significant cause of morbidity and mortality in the civilian setting, with 30-day amputation and death rates exceeding 10% in contemporary studies.…”

mentioning

confidence: 99%

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Increasing use of endovascular therapy in pediatric arterial trauma

Branco

Naik‐Mathuria

Montero-Baker

et al. 2017

Journal of Vascular Surgery

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The use of endovascular therapy in pediatric vascular arterial trauma has significantly increased, especially among severely injured blunt trauma patients. Despite this successful integration into care, there was no in-hospital survival advantage conferred by endovascular therapy compared with traditional open therapy. Approximately 10% of children with arterial injuries died during initial trauma assessment before therapy could be offered. Glasgow Coma Scale score ≤8, ISS ≥16, positive result of ethanol or drug screen, and systolic blood pressure <90 mm Hg on admission were identified as independent risk factors for death. As children are a population of vulnerable patients, long-term, multicenter studies are required to determine the most appropriate use of and indications for endovascular therapy in pediatric arterial trauma.

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Endovascular repair of traumatic axillosubclavian artery injuries

Zhang

Basu

Bauder

et al. 2022

Journal of Vascular Surgery Cases, Innovations and Techniques

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Uncertain Patency of Covered Stents Placed for Traumatic Axillosubclavian Artery Injury

Cited by 7 publications

References 24 publications

Endovascular Therapy of Vascular Trauma—Current Options and Review of the Literature

Endovascular Therapy of Vascular Trauma—Current Options and Review of the Literature

Increasing use of endovascular therapy in pediatric arterial trauma

Endovascular repair of traumatic axillosubclavian artery injuries

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