Society For Clinical Vascular Surgery

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Endovascular Management of Traumatic Subclavian/Axillary Artery Injuries
Nathan M. Droz, MD, Laura A. Peterson, MD, John H. Matsuura, MD, Garietta N. Falls, MD, Kamran A. Jafree, MBBS.
Wright State University, Dayton, OH, USA.

OBJECTIVE: Management of traumatic subclavian and axillary artery injuries are difficult due to complex anatomy for direct open repair. Endovascular techniques have rapidly evolved to now offer this subset of patients an alternative to open repair. We report our experience with endovascular management of traumatic subclavian and axillary artery injuries.
METHODS: Between January 2015 to June 2017, we retrospectively reviewed our database for subclavian or axillary artery injuries managed endovascularly with covered stent grafts. Demographic data, mechanism and location of the injury, mortality and long-term patency were recorded.
RESULTS: Six patients were identified with subclavian or axillary injuries managed by an endovascular approach. Four patients were subjects of gunshot wounds and two suffered injuries from a fall. Injury severity scores varied from 4 to 34. All patients were treated with covered stents via trans-brachial retrograde access. One patient required reoperation and repair of the brachial access. Two patients had combined abdominal exploration and simultaneous endovascular repair of their axillary artery injury. One of the six patients died from intra-abdominal bleeding though he underwent successful stenting of a left axillary artery. Three of the six patients have one year follow up with CT scan or arterial doppler studies showing patency of the stent graft and open runoff to the hand.
CONCLUSION: Our early experience shows successful management of both blunt and penetrating injuries of the axillary and subclavian artery using an endovascular approach. The advantages include a rapid approach to revascularization with less morbidity from open incisions and good short-term patency that does not restrict access for any need for future open reconstruction. In two patients, we were able to manage the injury simultaneously with abdominal exploration, avoiding delay in extremity reperfusion. As covered stent graft technology continues to evolve with smaller catheter size, we feel percutaneous management of these injuries will become a popular alternative to open repair.

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