Endovascular repair of traumatic injuries of the subclavian and axillary arteries

• Published in: Injury Vol. 36; no. 6; pp. 778 - 782
• Main Authors: Castelli, P., Caronno, R., Piffaretti, G., Tozzi, M., Laganà, D., Carrafiello, G., Cuffari, S.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.06.2005; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Axillary artery; Axillary Artery - diagnostic imaging; Axillary Artery - injuries; Axillary Artery - surgery; Biological and medical sciences; Blood Vessel Prosthesis; Blunt trauma; Catheterization - adverse effects; Dissection; Endovascular repair; Female; Humans; Iatrogenic trauma; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Pseudoaneurysm; Radiography; Retrospective Studies; Stent; Stent-graft; Stents; Subclavian artery; Subclavian Artery - diagnostic imaging; Subclavian Artery - injuries; Subclavian Artery - surgery; Traumas. Diseases due to physical agents; Treatment Outcome; Vascular Surgical Procedures - methods; Blunt trauma; Stent-graft; Subclavian artery; Stent; Dissection; Axillary artery; Iatrogenic trauma; Pseudoaneurysm; Endovascular repair; Prognosis; False aneurysm; Penetrating injury; Diseases of the osteoarticular system; Fracture; Epidemiology; Mechanism; Surgery; Complication; Graft; Repair; latrogenic trauma; Human; Iatrogenic; Mortality; Instrumentation therapy; Endovascular route; Method; Trauma; Morbidity; Standards; Lesion; Technique
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2004.12.046

Injury to the subclavian and axillary arteries is uncommon. Standard surgical techniques require wide exposure and dissection in traumatised areas which is often challenging and associated with significant morbidity, and mortality ranges from 5 to 30%. We report our experience with the endovascular treatment of these injuries. We retrospectively studied patients with blunt or penetrating (including iatrogenic) injuries to the subclavian or axillary artery between January 2000 and September 2004. Demographic data, mechanism of injury, concomitant injuries, angiographic findings, and treatment method and outcome were recorded. Nine patients with injury to the subclavian or axillary artery were seen at our institution during the study. Two patients underwent interventions, seven patients had lesions amenable to endovascular repair. Immediate success was obtained in all procedures (100%). All patients continue to have patent grafts with a follow-up ranging from 3 to 48 months (mean 22.6 months). The procedure-related complication was the need for a brachial artery pseudoaneurismectomy at the site of device insertion in one patient (14.7%). None of the patient developed a device fracture. Endovascular stent-grafts offer an effective, less invasive alternative to standard techniques in treating traumatic arterial lesions, resulting in shorter procedure time and less blood loss than previously reported.