Endovascular stent-graft repair of transected left subclavian artery

• Published in: Trauma surgery & acute care open Vol. 6; no. 1; p. e000696
• Main Authors: Jinadasa, Sayuri P, Hall, Michael R, Feliciano, David V
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 05.03.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Abdomen; Blood pressure; Carotid arteries; Case of the Month; Catheters; endovascular procedures; Esophagus; gunshot; Injuries; Ostomy; subclavian artery; Trauma; Ultrasonic imaging; vascular system injuries; Veins & arteries; wounds; United States > US; vascular system injuries; wounds; endovascular procedures; gunshot; subclavian artery
• ISSN: 2397-5776; 2397-5776
• DOI: 10.1136/tsaco-2021-000696

Focused abdominal sonography for trauma (FAST) examination Transfusion of blood products Infusion of 1 liter lactated Ringer’s solution Stat CT aortogram with contrast Management A Cordis central venous catheter was placed in her right femoral vein under ultrasound guidance, and she was transfused 1 unit of whole blood with a rise in her systolic blood pressure to 140 mm Hg. Attempts were made to cross the area of transection antegrade into the left axillary artery with multiple wire and catheter combinations without success. [...]it was decided to perform a modified version of Gilani’s approach to subclavian-axillary artery injury.1 Ultrasound-guided retrograde access to the left radial artery was obtained, and a 5-Fr sheath was placed. Discussion Injuries to the subclavian and axillary arteries account for 5% to 10% of vascular injuries in civilian trauma centers, mostly from penetrating trauma.2 3 The subclavian artery is located in the transition zone between the thorax, neck, and upper extremity, and, as such, it is protected by the thoracic outlet comprised of the clavicle, first rib, subclavius muscle, deep cervical fascia, costocoracoid ligament, and clavi-coraco-axillary fascia. Because of this protection, stab injuries do not lead to injury as commonly as gunshot wounds.1 2 The most common associated injuries include those to the subclavian vein, vertebral artery, carotid artery, brachial plexus, aerodigestive tract in the neck, lung, spinal cord, and sympathetic nerve chain.2 3 In the modern era, deaths are usually due to associated injuries.4 Open approach Prior to the endovascular era, open surgical exploration and repair was the standard approach for subclavian artery injuries. Because the subclavian artery is so well protected, it is challenging to gain access to the artery in an open operation, occasionally requiring multiple incisions.