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Background:
Subclavian artery injury may occur during the insertion of a central venous line or after trauma. There are several options for management of this dreaded complication.
Purpose:
To review the management of subclavian artery injuries.
Methods:
A retrospective chart review of all patients identified with a subclavian artery traumatic or iatrogenic injury during the insertion of a central line. Treatment included percutaneous insertion of a covered stent, closure device, open thoracotomy or a hybrid procedure. 30-day outcomes were recorded.
Results:
In a 3-year period, ending in August 2013, 13 patients, 7 women and 6 men (average age 61, range 40 to 85) were admitted for a variety of clinical conditions, all critically ill in the surgical intensive care unit. During resuscitation, attempted central venous line insertion of a 8 or 9 Fr introducer resulted in a subclavian artery iatrogenic injury, seven on the left and six on the right. Viabahn stent was delivered percutaneously in 7 patients and Bard Fluency in one. Three patients had Perclose and Starclose closure. One patient had open thoracotomy and repair of the innominate artery since the injury was at the juncture of the 2 great vessels. One patient had a hybrid procedure, an open thoracotomy with delivery of the Viabahn stent to the left subclavian through the ascending aorta. The last patient expired from intracranial bleeding before any repair was attempted. In addition to the latter patient, 3 others died of their underlying disease within 30 days.
Conclusion:
Traumatic and iatrogenic subclavian artery injury is difficult to manage. In most cases, a covered stent graft can be delivered percutaneously for a satisfactory repair. In select cases, a closure device can be attempted. Open thoracotomy is rarely required.