Background: Subclavian and axillary artery injuries are uncommon. In addition to many open vascular repairs, endovascular techniques are used for definitive repair or vascular control of these anatomically challenging injuries. The aim of this study was to determine the relative roles of endovascular and open techniques in the management of subclavian and axillary artery injuries comparing hospital outcomes, and long-term limb viability.
Methods: A multicenter, retrospective review of patients with subclavian or axillary artery injuries from January 1, 2004, to December 31, 2014, was completed at 11 participating Western Trauma Association institutions. Statistical analysis included χ, t-tests, and Cochran-Armitage trend tests. A p value less than 0.05 was significant.
Results: Two hundred twenty-three patients were included; mean age was 36 years, 84% were men. An increase in computed tomography angiography and decrease in conventional angiography was observed over time (p = 0.018). There were 120 subclavian and 119 axillary artery injuries. Procedure type was associated with injury grade (p < 0.001). Open operations were performed in 135 (61%) patients, including 93% of greater than 50% circumference lacerations and 83% of vessel transections. Endovascular repairs were performed in 38 (17%) patients; most frequently for pseudoaneurysms. Fourteen (6%) patients underwent a hybrid procedure. Use of endovascular versus open procedures did not increase over the duration of the study (p = 0.248). In-hospital mortality rate was 10%. Graft or stent thrombosis occurred in 7% and graft or stent infection occurred in 3% of patients. Mean follow-up was 1.6 ± 2.4 years (n = 150). Limb salvage was achieved in 216 (97%) patients.
Conclusion: The management of subclavian and axillary artery injuries still requires a wide variety of open exposures and procedures, especially for the control of active hemorrhage from more than 50% vessel lacerations and transections. Endovascular repairs were used most often for pseudoaneurysms. Low early complication rates and limb salvage rates of 97% were observed after open and endovascular repairs.
Level Of Evidence: Prognostic/epidemiologic, level IV.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/TA.0000000000001645 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Axillary to Superior Mesenteric Artery Bypass as a Viable Solution for Chronic Mesenteric Ischemia.
Cureus
December 2024
Vascular Surgery, Carle Foundation Hospital, Urbana, USA.
Chronic mesenteric ischemia (CMI) is a progressive condition that primarily affects the elderly, causing chronic abdominal pain and malnutrition. Timely treatment is essential to prevent further deconditioning or bowel ischemia. Surgical repair options include both endovascular and open procedures.
View Article and Find Full Text PDFComplications on the feeding artery after an arterio-venous fistula closure in patients after kidney transplantation - a national cohort study.
Clin Kidney J
January 2025
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Background: Arteriovenous fistulas (AVFs) in kidney transplant recipients are sometimes closed, either as a policy or due to complications. We collected data on the incidence of complications after AVF closure in a national cohort of transplanted patients.
Methods: Patients who received a kidney transplant between 2000 and 2015 and had a functional AVF that was later ligated or extirpated were included.
Anatomical variations and surgical implications of axillary artery branches: an anatomical study of the coracoid process region.
Anat Cell Biol
January 2025
Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
The complex of neurovascular structures surrounding the coracoid process, particularly the axillary artery, the thoracoacromial artery and theirs branches, plays a critical role in shoulder function. Detailed dissection was performed in 36 shoulders from 18 embalmed cadavers. The focus was on axillary artery branches in relation to the coracoid process and the documentation of anatomical variations in this area.
View Article and Find Full Text PDFSurgical revascularisation in an adult with coarctation of the aorta.
BMJ Case Rep
January 2025
Department of Cardiothoracic and Vascular Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
One of the most common congenital cardiac anomalies is It accounts for 4%-6% of all congenital heart defects. A CoA case surviving into adulthood may result in hypertension, weak femoral pulse, limb and bowel ischaemia and heart failure. A man in his early 20s presented with severe lower limb and abdominal pain with long-standing hypertension, refractory to antihypertensives.
View Article and Find Full Text PDFInflammatory and Hemolytic Responses of Microaxial Flow Pump Temporary Ventricular Assist Devices via Axillary Access in Cardiogenic Shock.
Medicina (Kaunas)
November 2024
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
The use of temporary left ventricular assist devices (tLVADs) for patients suffering from cardiogenic shock (CS) is becoming more common. This study examines the indications and outcomes of microaxial flow pumps (Impella, Abiomed Inc., Danvers, MA, USA) when cannulated through the axillary artery in patients with severe CS, with a particular focus on acute phase reactions and hemolytic responses.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!